PRICE vs MEAT
On a daily basis unexpected injuries are sometimes unavoidable and can range from mild to severe. These injuries can happen to a trained athlete, runner or sportsman, or simply rolling our ankles on a piece of uneven ground in our regular daily activities. Due to many reasons or factors such as the demands of school and jobs, many people will try to manage these acute injuries at home before consulting a physiotherapist or doctor. However, are we following the best protocols at home?
For many people around the world protocols of protection, rest, ice, compression, and elevation (PRICE) has been the best way to manage an acute injury from its onset until it is resolved with a physiotherapist. PRICE is defined under the following terms:
- Protection: protect the injured area by splinting, strapping or bandaging it to decrease movement. Crutches may also be used to decrease load on the affected structure.
- Rest: decrease usage of the injured area and stop exercises to prevent further damage and pain.
- Ice: apply ice to injured area for approximately 15 minutes until the area is numb, to effectively manage swelling and pain. Please do not apply directly to the skin, in order to avoid ice burns. Please do not leave ice on for prolonged periods either (we normally recommend it to be on for a max of 15mins each time)
- Compression: apply compression to decrease hemorrhaging, swelling and to decrease excessive blood flow to the area.
- Elevation: elevate the area of the injury in order to decrease the pressure in the blood vessels to minimize swelling and bleeding.
PRICE is primarily designed to decrease inflammation, blood flow and further damage to the already injured parts immediately after the injury and is usually indicated for use for at least 48 hours following an acute soft tissue injury. Following these initial stages of recovery however, an increase in blood flow to damaged tissue is how our bodies begin to heal themselves.
In ordinary circumstances, soft tissue structures such as tendons, ligaments and cartilage don’t get a large amount of blood flow and by limiting the supply of blood to the areas with PRICE, we often prolonging their healing process. Increased blood flow to injured soft tissues supplies these areas with oxygen rich blood filled with nutrients, and assists in the removal of toxins and wastes that have built up as a natural result of the body’s reaction to the injury sustained. These toxins are filtered to the lymph nodes and kidneys where they are naturally removed from the body as part of the natural management process of healing.
Prolonged use of the PRICE principles may run the risk of an increased time of deceased blood flow to these affected areas, which may increase the time taken for healing. When the healing process is prolonged, many people get impatient and often return to their activities with ligaments and tendons that are not completely healed. This may result in a chronic instability of a joint and this often results in recurring injuries.
Recent research has led us to believe that the PRICE principles may not always be the best way to optimize healing and that it could be more optimally used in conjunction with movement, exercise, analgesics, and treatment (MEAT).
MEAT is an alternative method of management of acute injuries, which increases blood flow in order to enhance healing of soft tissues injuries. This principle is based on implementing controlled activity and movement as soon as possible in order to restore normal function to affected parts of the body. MEAT (movement, exercise, analgesics, and treatment) increases blood flow to injured areas in order to propel the healing process by normalizing their function and blood supply. MEAT is defined under the following terms:
- Movement: most importantly is movement. This puts a controlled amount of load on a system, helping the tissue form and heal in the correct, organised manner, which increases it’s strength. It is important for the movement to be gentle and within the limits of pain throughout the rehabilitation program. Movement is also crucial for flushing out toxins and debris from the area, and for bringing nutrient-rich blood into the affected tissue in order to aid in the healing process.
- Exercise: the next level is exercise which is started once the pain has decreased and the movement of the affected area has been restored back to normal ranges. Once again, these should be started off very gently and in a controlled manner as the tissues are all in a delicate state as they heal from their injury. Exercises will be done according to what structures are affected and stretching should always be added, to maintain good range of movement. Exercises will further promote the increase of blood flow and nutrients into the tissue and the removal of debris from damaged tissue.
- Analgesics: pain has been shown to decrease our ability to heal and it is therefore very important to manage pain effectively. The prescription of appropriate pain management modalities after acute injury is crucial for effective healing and recovery. This may be in the form prescription medication, and from a nutrition point of view, where nutrition advice is considered very important. A healthy diet is used to enhance efficient function of the body. Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen should be avoided as they reduce inflammation in the body, which results in decreased blood flow, and this would have a prolonged healing time at the injured area.
- Treatment: this phase refers to the appropriate implementation of manual, active or passive treatment by a physiotherapist in order to breakdown any built-up muscle tension, damaged tissue areas, trigger points, joint adhesions or limitations, myofascial or soft tissue adhesions or points of pain. The physiotherapist may also make use of supplementary and assistive tools such as ultrasound, electro therapy, strapping, or dry needling to assist in the rehabilitation process.
It is important to remember that there is no set standard or rule for every injury or for every person. We are all different, we all heal differently and we all deal with pain differently. Each of us is unique in our own ways and so are our bodies. We all require our own approach to treatment for any injury or rehabilitation process.
As a general rule of thumb, PRICE is appropriate for acute management within 24 hours of injury to immediately manage pain and swelling, and possibly as a supplement for managing increasing levels of pain with aggravating factors, such as after a very busy day at work. For the larger majority of sprains and strains, MEAT is advised, after pain has become manageable, as it supports increased blood flow and tissue healing, which improves recovery and positive outcomes. Rest is important in the initial phase, but in moderation, because when an injury is kept in the same position the collagen fibres (scar tissue) can grow back incorrectly and this can decrease future stability.
Although there is a time and place for the PRICE principles, our aim should be shifted towards MEAT – where appropriate and where pain is managed, as it is shown to better support healing, which is the ultimate goal!