Use METH, not RICE on Sprains
(No, not THAT Meth!)
No doubt you’ve heard that RICE (Rest, Ice, Compression, Elevation) or PRICE
(Protection, Rest, Ice, Compression, Elevation) is the way to treat an ankle or wrist
sprain. What would you say if I told you that METH is actually better for a sprain? No,
not *that* meth. This METH is an acronym for Movement, Elevation, Traction, Heat.
Recent research has disputed the effectiveness of using ICE on an injury. Rather, the
latest round of thinking uses HEAT to heal a sprain. Many practitioners are doubting the
claim that ice helps healing and inflammation. It certainly helps with the pain. Many
practitioners, like Dr. Bahram Jam, claim that ice is actually counterproductive to proper
natural healing.i
What Does Cold Do?
Cold therapy for minor sprains is used to reduce swelling and inflammation, pain, and
edema and blood flow. RICE is meant to reduce blood flow and swelling (elevating the
part above the heart, thereby reducing the amount of blood sent to that area, putting
pressure and using ice).
It is also worth remembering, however, that swelling and inflammation are a natural
response to injury. The localized swelling is the body’s way of healing itself. When one
incurs an injury, the body immediately begins to send blood to the injured area.
Applying the ice or cold pack to an injury constricts the blood vessels, thereby making it
more difficult for the healing inflammation cells to do their work. More and more
practitioners are realizing that using ice on an acute injury impedes this process, which
delays healing.
Studies Questioning RICE
A study by Tseng in 2012 suggested that topical cooling (icing) seems to not improve
but rather delay recovery from exercise-induced muscle damage.ii
Van den bekeron (2012) conducted a meta analysis of the Cochrane database,
Medline, CINAHL and EMbase. They identified 11 trials with 868 patients that described
the treatment outcomes (pain, swelling, ankle mobility or range of motion, return to
sports, return to work, complications, and patient satisfaction). They discovered
insufficient evidence that the RICE method makes any difference to the treatment
outcome.iii
Why Heat Works
Toronto-based trainer and exercise physiologist John Paul Catanzaro coined the phrase
METHiv. Applying heat (wheat bag, electric blanket, heat creams, etc.) to an injury after
icing it causes the blood vessels to dilate (open) which helps to heal the damaged
tissue. A study by Malanga published in 2015 noted that there is limited overall
evidence to support the use of topical heat in general. However, randomized controlled
trials have shown that “heat-wrap therapy provides short-term reductions in pain and
disability in patients with acute low back pain and provides significantly greater pain
relief of delayed onset muscle soreness (DOMS) than does cold therapy.”v
On the other hand, the use of heat increases vascular flow and can remove heat from
the site of inflammation due to increased circulation. It is important NOT to use heat
during the first few hours of injury, as this may make inflammation worse and cause
bruising.
Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool
an injured part for short periods soon after the injury occurs. Dr. Gabe Mirkinvi, who
coined the RICE phrase, notes that “[there] is no reason to apply ice more than six
hours after you have injured yourself.” He does not, however, recommend any type of
heat therapy.
TCM and Ayurvedic Indian Medicine
This way of thinking is hardly new. Traditional Chinese Medicine has treated sprains
with heat for thousands of years. The Chinese believe that applying ice to an injury is
detrimental because it stagnates the blood and qi circulation. Therapy includes
acupuncture and moxibustion (a heat treatment using dried mugwort). The goal is to
reduce the swelling while enabling adequate blood flow. TCM practitioners believe that
an injury should be massaged right away, which will heal the injury sooner. Rather than
immobilizing the joint, TCM actually moves the joint as soon as possible.
Conclusion
Cold therapy may only be beneficial in the first few hours following an acute injury. After
this initial period, the negative effects of cold therapy outweigh the benefits. In this
period the use of heat therapy may also be detrimental as it may exacerbate
inflammation and bruising.
After the initial period of injury heat therapy is more appropriate, helping to restore
circulation and promote healing after an acute injury.
References
i
Jam, Bahram.(2014, May 20) Questioning the use of ICE Given Inflammation is a
Perfectly Healthy Response Following Acute Musculoskeletal Injuries. Retrieved from
http://www.aptei.ca/wp-content/uploads/ICE-Paper-2014.pdf
ii
Tseng, CY, et al. (2013). Topical cooling (icing) delays recovery from eccentric
exercise-induced muscle damage. Journal of Strength and Conditioning Research,
27(5), 1354-61. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=22820210
iii
Van den Bekerom, MPJ, et al. (2012). What is the evidence for rest, ice, compression
and elevation therapy in the treatment of ankle sprains in adults? Journal of Athletic
Training, 47(4), 435-443. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/
iv
Cantanza, John Paul (2015, Sept 20). The New Injury Rehabilitation Paradigm: RICE
Is Not NICE, Do METH Instead! Retrieved from
http://theelitetrainer.com/index.cfm?t=Blog&pi=BLOG&blid=73
v
Malanga, GA, et al. (2015). Mechanisms and efficacy of heat and cold therapies for
musculoskeletal injury. Postgrad Medical Journal, 127(1), 57-65. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/?term=25526231
vi
Mirkin, Gabe (2015, Sept 15). Why ice delays recovery. Retrieved from
http://www.drmirkin.com/fitness/why-ice-delays-recovery.html