By Steven Smith, PTA, Tulsa Bone & Joint
For the majority of people out there who have sustained an acute injury, such as an ankle sprain, you have probably heard of the RICE method. This method quickly became the go to protocol for quick assessments of such injuries as of 1978 when it was created by Dr. Gabe Mirkin, MD in his best selling “Sports Medicine Book.” The guidelines for this protocol have since been used by coaches, athletic trainers, and physical therapy clinics with the intent of expediting the recovery process and reducing inflammation for acute injuries. However, as people are paying closer attention to results and the long- and short-term effects, they are finding it may not be the best way to address such injuries. A new era of treatment is evolving, where the MEAT protocol is proving to potentially be the better path.
There are varying opinions/problems with RICE:
- Rest. Studies have shown that it can actually be detrimental to the healing process. As the “Journal of Athletic Training” in 2012 points out, with earlier movement of the tendons, ligaments, and muscles injured, it could result in less time at a follow up clinic, or away from sport.
- Ice has long been the go-to for the prevention of swelling and reduction of pain at the injury site. But ice has been noted to actually delay and potentially reduce the healing process, as some people commonly confuse inflammation and swelling. The two in fact are vastly different, as inflammation is the first phase of the tissue repair, while swelling is accumulation of waste that has not yet been evacuated from the area. Inflammation is an important part of the healing process as an instantaneous defense mechanism whose main goal is to control the extent of cell injury, and preparing that tissue for the process of repair. Injuries to structures that have limited blood supply like ligaments, tendons, and cartilage are hindered by cryotherapy, which reduces blood flow thus prolonging the healing process in the acute stage. The RICE method wants to reduce swelling and decrease blood flow to the injured area. However, blood flow invites more oxygen and more nutrient- rich blood to the area which ultimately accelerates your recovery.
There is a substantial amount of evidence to support the new era of MEAT, and that gentle movement and exercise help expedite recovery, improve range of motion and blood flow, and prevent instability in the joint post injury. Movement should be started as quickly, and without exceeding pain tolerance, as possible. Gentle movements will allow for a small amount of load on the ligament, which could help the tissue grow back in a stronger way.
Rest is important when it comes to an acute injury, but in moderation. This is because collagen fibers (scar tissue) can quickly build up if a joint is left in the same position for extended periods, ultimately threatening long term stability. Evidence has shown that the more movement to the injury, the stronger and more flexible it will be in its healing process.
Analgesics are pain relieving medications that can be helpful to allow for movement and exercise before pain starts. Though these should not generally be anti-inflammatory for reasons listed above, as inflammation is important to the healing process. Over the counter medications that are good options include Advil, Ibuprofen or Tylenol, but always consult with your doctor first to decide which is safest for you!
The last two steps, Exercise and Treatment, go hand in hand, as a structured exercise determined by therapists in a treatment setting will show greater results than rest alone. A structured exercise routine will create functional stability and strength with a regimen and manual techniques provided by a certified therapist, and potentially prevent recurrent injuries. Therapeutic guided exercise is an excellent form of rehabilitation that minimizes the detrimental deconditioning effects of rest and immobility. These include muscle atrophy and weakening of connective tissue, such as tendons and ligaments.
While there is still not sufficient side-by-side evidence to prove that MEAT is in all cases superior than RICE, there is sufficient evidence that shows that movement, exercise, and treatment from a physical therapist leads to a faster, more complete healing than rest, elevation and compression.
March is National Athletic Training Month, and we’re using this opportunity to highlight the amazing Athletic Trainers employed by Tulsa Bone & Joint. These trainers work in high schools, in our clinic, and elsewhere to help athletes perform at their peak ability and to recover quickly if an injury occurs.
Johnathon Millwee is the Athletic Trainer for FC Tulsa, Tulsa’s professional soccer team. Tulsa Bone & Joint is proud to be the orthopedic provider for FC Tulsa and to sponsor Johnathon as the team ATC.
Here’s what FC Tulsa player Eric Bird has to say about Johnathon:
“Johnathon is our go-to guy. He’s a jack of all trades. He has so many different roles within our team, and he’s a guy that is a glue for us here. He doesn’t just do the athletic training, he does so much more. He’s a blessing for us all, can’t say enough good things about how he treats the guys and what he means to this group as a whole.”
Q&A with Johnathon Millwee
Q: Why did you decide to become an athletic trainer?
A: Becoming an athletic trainer for me was a shot in the dark chance before I dropped out of school. I received a call from a close colleague telling me to go to Mike Catterson (head athletic trainer at Jenks High School) and ask about athletic training as a career. I was given a fanny pack with some gauze and Band-Aids and was told to observe practice. Playing football/baseball was all I ever wanted to do in college, so it was extremely difficult for me to watch something I had spent my whole life playing.
In a split second, a major injury happened, and I was able to watch how everyone worked from the athletic training side all the way up to the surgeons. I went back the next day and asked, “Where do I sign up?” I was fascinated at how a player could recover to go back on the field after such a major injury.
Q: What do you enjoy the most about your job?
A: My favorite part of my job is the ability to be a forever learner. I love learning why the things we did in the past might not have been the best way to do things, and how we could adjust them for the better in the future. This boils down to how we rehab, how we look at movements of the different body parts, how we make adjustments before an injury happens and how we treat acute/chronic injuries.
Q: What has been a career highlight for you so far?
A: Getting the opportunity to work the College Softball World Series and meeting and spending time with Lisa Fernandez between games and also playing as lead body guard for OU after their National Championship as they walked to their buses.
Johnathon, thank you for all you do to make FC Tulsa and Tulsa Bone & Joint a winning team!
As a former collegiate athlete myself, I try to keep the athlete’s best interest at heart. With the recent recommendations from the AMSSM and AOSSM, my job as a sports medicine physician is to help educate athletes, parents and coaches about the dangers of sports specialization at a young age.
According to a study by the American Academy of Pediatrics in 2018, athletes who specialize in a single sport are 81% more likely to experience an overuse injury. However, multi-sport athletes have less potential for injuries, burnout and have a higher likelihood of scholarship opportunities at the college level.
Studies suggest that early sports specialization engages frequent repetitive movement, which leads to higher stress in muscles, ligaments and tendons. In a growing child, this is a perfect storm for injury patterns to develop. This in turn leads to burnout and decreased athletic performance.
How to prevent burnout and overuse injuries:
- Limiting repetitive movement in sport and training, for example, high pitch counts during practice and games.
- Preseason conditioning programs and 2+ hours a week in injury prevention training can reduce the risk of injury.
- Plan on periods of isolated and focused integrative neuromuscular training to enhance diverse motor skill development and reduce injury risk factors.
- Ideally, give yourself two consecutive months/year away from the specialized sport to allow the body to recover.
- To reduce the likelihood of burnout, emphasis should be placed on skill development rather the competition or winning.
Multi-sport athletes tend to be better athletes and have the potential for collegiate scholarships and professional contracts. Encourage your athlete to have fun, and remember: If they are not, they may be suffering from burnout or an overuse injury.
Dr. Reddy is a sports medicine fellowship-trained and board-certified physical medicine and rehabilitation specialist (physiatrist).
He completed a six-year medical school program at Stanley Medical College in India.
He completed his two-year Master’s at the University of Mankato in Minnesota with an emphasis on Human Biomechanics and Exercise Physiology.
Dr. Reddy completed his four-year residency in Physical Medicine & Rehabilitation at the reputed Washington University in St. Louis, Missouri.
He completed his fellowship in Sports Medicine under the tutelage of the world-renowned sports medicine specialist Dr. James Andrews at the Alabama Orthopedic & Sports Medicine Center in Birmingham, Alabama.
After completion of his fellowship, he moved to Tulsa in 2000 and has been in practice ever since. He has seen over 150,000 patients.
As a non-surgical sports medicine/musculoskeletal specialist, Dr. Reddy sees patients with a wide variety of orthopedic problems. He coordinates with surgical partners at Tulsa Bone & Joint on various diagnostic and therapeutic procedures. These procedures include EMG/Nerve Conduction Studies, spine injections under fluoroscopy, ultrasound guided injections of various joints and soft tissues, and more recently, regenerative medicine-related procedures (PRP, Stem Cells, etc.).
Along with other partners in the group, he helps cover high school athletics, including football games on game day. Dr. Reddy enjoys teaching medical students and residents and has about 8-12 rotate with him each year.
Dr. Reddy is married with two children. His son plays Division 1 golf and is an aspiring medical student. His daughter is a sophomore in college and also an aspiring medical student.
Dr. Kilambi is fellowship trained in Sports Medicine and Arthroscopy from the Cincinnati Sports Medicine and Orthopaedic Center and board certified through the American Board of Orthopaedic Surgery.
Dr. Kilambi completed his residency in Orthopaedic Surgery, Naval Medical Center in San Diego. Originally from Arkansas, Dr. Kilambi completed medical school at the University of Arkansas for Medical Sciences in Little Rock.
Along with Dr. Nunley, Dr. Kilambi serves as the team doctor for Owasso High School. Dr. Kilambi specializes in a number of treatments, including joint injections, ligament repairs/reconstruction, rotator cuff repair, ankle injuries, tennis elbow treatment, general fracture care, knee and shoulder scopes, carpal tunnel syndrome, and more. We’re so glad to have Dr. Kilambi on our team!