Acute injuries on the sports field
Do you know how to manage acute injuries on the sport field? Physio Shelagh Green takes a look at R.I.C.E. versus M.E.A.T. treatments.
Do you want R(est) I(ce) C(ompress/stabilse) E(levate)
or M(ove) E(xercise) A(nalgesics) T(reat) with your injury?
In 1978 Dr Gabe Mirkin coined the R.I.C.E. acronym and this has had coaches calling for an ice pack as a first response to a player going down on the field ever since. But we now understand tissue injury much better than back in 1978 and we are shifting our thinking about acute injuries. The main aim of RICE was to restrict inflammation as much as possible, but inflammation is actually so important to the healing process because the cells and enzymes that repair damage in our bodies are brought to an injury site via the inflammatory process.
Dr Mirkin himself has changed his thoughts. He has reviewed 22 case studies and has concluded that the evidence for using ice to promote healing is insubstantial.
For on-field management of acute injuries we don’t follow the RICE steps in order:
STEP 1. Rest: if a player has hurt themselves get them off the field to assess the damage.
STEP 2. Compress/Stabilise: This means you want to immobilise the injured area to prevent further damage for excessive movement of the area, but you do not want to restrict blood flow into the area as we now know that your body will be trying to kick start the healing process by sending cells and enzymes to the injury. So for example, do not take a shoe off an ankle injury, but there is no need to tighten the laces further.
STEP 3. Ice: Do not use ice as a standard treatment for each player. We want a certain amount of inflammation to happen to kick start the healing process. I would only ice if I could see visible bruising immediately after the injury. This bruising shows that there is active bleeding due to damaged blood vessels in the muscle or tendon and you do want to stop this. I would ice for a maximum of 15 mins every hour. The ice will cause the blood vessel to contract and reduce the bleeding into the tissue. If you apply the ice for longer than 15 minutes that the body will force the blood vessels in the area to open fully again as the brain gets worried about the skin being damaged by hypothermia.
STEP 4. Elevate: By now your player might be going into a little bit of shock and by placing the injured area above the level of their heart you will need to get them lying down. This helps with blood flow back to the heart and brain and can stop the player from feeling too dizzy from shock. It is not to reduce blood flow to the area, as we want that super-important inflammatory soup to start the healing process.
At this point you need to get your player to a physio to be properly assessed and to start the M.E.A.T. process. Research is showing that by starting to move or exercise an injury correctly in the early stages of acute injuries can speed up the time taken to get back to sport. Analgesic medication is useful to keep pain under control. And TREAT the injury correctly!