What to do when you are injured: RICE vs. MEAT vs TEA
I’m writing this blog post with a broken arm. Last Wednesday I took a hard fall on the ice. I was taking out the garbage and getting the mail. I stepped away from the garbage can, took a single step toward the street, and in less than a blink of an eye I was on the ground. It happened so fast, there was no possibility of catching myself or falling gracefully. I sat there for a moment and took stock: Can I move my limbs? Yes. Can I stand up? Yes. Can I walk? Yes. I moved slowly out to the mailbox. My wrist hurt, but I could move my fingers. When I got back in the house, I knew that I wasn’t okay. I was shivering uncontrollably. I was nauseous. My vision had narrowed. I was having difficulty articulating myself. I realized that I had broken my arm. Jay took me to the ER. An x-ray confirmed the break. Luckily, it was a clean break of the left radius (thumb-side forearm bone) and there was no need for surgery. I left the ER with a cast-splint, a prescription for opiates (that’s another blog post) and a referral to an orthopedist. Luckily, the orthopedist swapped the big splint that limited my finger and elbow motion for a forearm cast. It’s so good to have use of my elbow and finger again.
I was taught how to treat injuries with the acronym RICE: Rest, Ice, Compression, Elevation. The overall lesson was, stay off the injury, reduce the swelling and limit the pain. It seemed to work. But I don’t think most of us ever particularly tried a scientific experiment to compare whether or not this treatment actually improved the rate or quality of healing. However with time, sports scientists have begun to question the RICE treatment protocol. Asking the question: does avoiding inflammation, our body’s natural response to injury, actually help or limit healing?
After an injury the body floods the injured region with fluid that creates inflammation. This fluid serves a number of important purposes: 1) it creates a natural splint to prevent you from reinjuring the tissues; 2) it floods the area with your own natural antibiotics and the materials and chemicals needed to heal and rebuild tissue; 3) it presses on nerves, causing pain to stop you from reinjuring the tissues. Recent studies suggest that preventing inflammation at this critical time can inhibit the healing process. Ice, compression, elevation and NSAIDs are all intended to reduce inflammation and can inhibit the healing process as a result. NSAIDs in particular, while reducing pain, are believed to slow healing. So, what to do?
A number of physical therapists have shifted to the treatment acronym MEAT: Movement, Exercise, Analgesia, Treatment. I understand where these therapists are coming from, but 1) A few of these categories seem redundant and forced; 2) Treatment is rather self-serving, as it is encouragement to see a PT. Sometimes needed, sometimes not; 3) MEAT as a treatment protocol just sounds kinda gross. So, I came up with my own acronym and treatment protocol: TEA
Time: rest, give it time, have a cup of tea, take a day off, return to motion slowly as the pain subsides.
Exercise: start with gentle range of motion and isometric contractions of the injured tissues, gradually increase load and range of motion. Work with a professional as needed.
Analgesics: use pain relievers sparingly. Use the lowest dosage and the least invasive analgesic possible: Arnica, peppermint and/or camphor, ice and/or heat, acupuncture, massage, Tylenol, Ibuprofen.
So, where am I personally on this journey with my broken arm? It’s been less than a week so…
Time: I’ve taken time off. Because the bone is broken, I’m following the orthopedist’s advice. My forearm is in a cast to insure that I rest it. The bone will need 4 to 6 weeks to knit itself back together. I’m avoiding lifting or pushing with the injured arm. A month feels like a long time but I know it will go by quickly. So, time feels like the first and foremost treatment protocol I need to pay attention to. Being patient with myself is hard for me. Healing is energy intensive. I’m exhausted at the end of my days even though I don’t feel like I have done much. I keep reminding myself to give myself Time to heal.
Exercise: I long to Exercise. Yesterday I went for a short walk. Today I walked a little farther. It’s a mess of slush out on the byways of Corvallis, so that is a good deterrent from doing too much. At this early stage of healing, I’m carrying the cast around, moving my fingers and elbow, and doing simple isometric contractions of the muscles inside the cast. As I start feeling better, I hope to begin doing adaptations of my usual yoga/pilates/weight lifting/walking routines. As much as it saddens me, I’m going to stay off my bike until the doctor gives me the thumbs up to ride.
Analgesics: Here’s the reality, I don’t want to be in too much pain. I took ½ of a Norco on the first night to sleep. I don’t think that was a sufficient dose to do much of anything and I haven’t taken any since. For the first couple of days I took minimal amounts of ibuprofen, just enough to take the edge off the pain. I’ve been taking homeopathic Arnica Montana and Symphytum Officianale. I’m using essential oil of wintergreen, birch, lemongrass, white fir, marjoram, helichrysum and lavender 3 times a day. I’ve scheduled bi-weekly acupuncture at Corvallis Community Acupuncture. And I had a massage yesterday. I’m going heavy on the alternative therapies. Even if they are placebos, if I believe in them they might help. And if they don’t help I know they won’t hurt.
So, the next time you’re injured, have a cuppa TEA and skip the RICE and MEAT.
I’ll be back at the Live Well Studio on Wednesday, 1/11/16. Hope to slowly work my way back into teaching over the next week while taking my time and not overdoing things.
NSAIDs and possible bone healing impairment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259713/
NSAID therapy effects on healing of bone, tendon, and the enthesis
Do NSAIDs Impair Healing of Musculoskeletal Injuries?