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R.I.C.E. is on Ice

Updated: Sep 18, 2023

Let's Explore a Meatier Approach to Treating Injuries





We need to have a serious discussion regarding the R.I.C.E. (Rest, Ice, Compress, Elevate) protocol, which has been diligently followed for a significant period of time - precisely 45 years. However, recent findings have revealed that this protocol may not be as effective as initially believed.


One of the most widely recognized acronyms in the English-speaking world was coined by Dr. Gabe Mirkin in 1978, as documented in his "Sports Medicine Book." This acronym gained popularity among physiotherapists and medical professionals globally. However, it was based on research that is now considered incomplete, and Dr. Mirkin himself acknowledged his advice was flawed a decade ago, in 2013, due to a wealth of new evidence.


Before we explore the details, let's first discuss the lymphatic system, which plays a crucial role in our bodies. It functions as a cleaning crew, eliminating infection-fighting immune cells and waste. Lymph, a clear fluid, passes through lymph nodes, undergoes immune cell activation, and then returns to the bloodstream through lymph ducts located beneath the collarbones. However, here's the important part: the lymphatic system relies on muscle movement and blood flow to perform its duties effectively.


Research has shown that icing the injury actually disrupts the functioning of the lymphatic system. Instead of efficiently removing inflammatory fluid, the application of ice exacerbates the situation by increasing the permeability of the lymphatic system and causing swelling. Rest may seem beneficial, but it hampers muscle movement, impeding the flow of contaminated fluid through the lymphatic vessels. Compression and elevation, despite good intentions, end up restricting both blood and lymph flow. It's indeed disappointing.


However, there is now the M.E.A.T. protocol. M.E.A.T. stands for Movement, Exercise, Analgesics, and Treatment. This fresh approach to injury recovery is supported by the latest research.


The M.E.A.T. protocol emphasizes early movement within a pain-free range. It involves gentle flexion and extension of the injured joint, which helps stimulate blood and lymph circulation, thereby promoting faster healing. Gradually incorporating targeted exercises, appropriate pain management, and seeking professional treatment can make a significant difference in your recovery journey.


Furthermore, recent research advises against the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen and naproxen. These findings challenge their previous widespread use.


Surprisingly, the R.I.C.E. protocol continues to be advocated by many, including esteemed institutions like the NHS. The updated advice on the NHS website for soft tissue injuries, as of 2021, still recommends using the R.I.C.E. protocol. Most of this advice is not scheduled for revision until 2024. However, it is essential to update our knowledge based on the latest research. We owe it to ourselves and the public to disseminate this information, question outdated practices, and encourage healthcare providers to embrace the M.E.A.T. protocol.



Now that the truth about the limitations of the R.I.C.E. protocol are known, it is imperative that we embrace the M.E.A.T. approach. Early movement, personalized exercises specific to the injury, effective pain management, and professional treatment are the fundamental components for expediting recovery. It is time to discard outdated practices and elevate our injury management to a whole new level. By staying informed and sharing this knowledge, we have the power to revolutionize the way we heal and assist others in bouncing back stronger than ever before.


Undoubtedly, many of you may have valid questions regarding this paradigm shift. For those seeking a comprehensive understanding of the topic, I recommend an enlightening article that delves into the history of the R.I.C.E. protocol, provides insights into its shortcomings, and includes links to relevant research papers. You can find the article at the following link: [ResearchGate Article]



Those with an acute injury who've been in to see me will know my "A" also stands for an Apple Cider Vinegar (AVC) poultice to dissipate hot and/or red swelling. To find out how to use AVC as a poultice, click here.










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