All Posts tagged RICE

RICE versus METH – A new approach for healing soft tissue injuries

RICE versus METH – A new approach for healing soft tissue injuries

When you sprain, strain or injure a soft tissue structure, immediately most individuals apply the RICE acronym. RICE stands for Rest, Ice, Compression and Elevation. Recently, a Toronto-based trainer and exercise physiologist, John Paul Catanzaro, coined a new acronym to deal with soft tissue injuries – METH.

METH refers to Movement, Elevation, Traction and Heat. As a health professional, I find this method works extremely well for my patients who commonly seek treatment for ankle sprain/strains, hamstring pulls, lateral/medial epicondylitis (tennis/golfer’s elbow) and other soft tissue injuries.

Catanzaro, as well as several health practitioners, criticize the icing method and believe that ICE will slow down blood circulation and thus the healing process. I agree. Ice is great at removing immediate pain and swelling following an injury, however, it will also constrict blood flow. This constriction in blood flow may limit the flushing of inflammation out of the injured region, thus, creating more pain and making healing time longer.  Applying moist heat (I do this for around 5-10 minutes at a time) can be found to do the opposite – it increases circulation and healing times.

Elevation, our second word in the METH acronym, is said to assist with moving blood from the limb to the heart. By elevating a limb above the heart, we allow gravity to bring blood back to the heart/lungs. This assists in flushing swelling/inflammation out from the area.  Compression, part of the RICE method, is also meant to reduce swelling in the area.

Movement and traction are very similar in the METH approach. Both focus on the importance of moving the injured soft tissue area frequently but with caution. Avoid keeping the area still or resting for too long (I would say for over 30 minutes). Remember, movement will assist in preventing stiffness, pain, as well as swelling, however, do this with caution!

All in all, I still believe that a balance between the RICE and METH methods are important depending on the severity of the injury, region injured, and duration/time lapse following the injury. For instance, ice can assist in decreasing pain and maybe necessary if anti-inflammatories or painkillers are not assisting.  The bottom line is that we need to be open-minded in our approach to treating soft tissue injuries.  What works for one person, may not work well for someone else. Next time you think RICE, consider the METH method for treating that acute soft tissue injury.

MEDICAL DISCLAIMER: The following information is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.


Ice or Heat? What do I use for my injury?

Ice or Heat? What do I use for my injury?

Today, I thought I would touch upon a question that I get asked quite often in practice.   When should I use Ice and when should I use Heat?  What is the difference between ice or heat for treating my injury?

These are both interesting questions and something that I would like to address in this blog.

When to use ICE or Cryotherapy?

Ice or cryotherapy is usually used for pain relief and inflammation immediately post injury (acute phase of injury).  With ice usage, inflammation, edema (swelling), hemorrhage, as well as how fast your nerves conduct decreases, while pain tolerance increases.  Generally, ice should be used throughout the inflammatory process (acute phase of injury).  This process typically begins immediately post injury and lasts between 3 to 5 days.  Along with ice, individuals may use a technique called RICE. 

What is RICE?  

Rice stands for rest, ice, compression and elevation.  For instance, when one presents with an acute ankle sprain, this technique can be used. By resting, one avoids aggravating the area further, by icing and compressing, one can decrease swelling, and by elevating one focuses on draining swelling back towards the heart.  Cold/ICE should be applied during the first 4 hours post injury at intervals of 10 minutes every 30-60 minutes.

When do I use HEAT Therapy?

Heat is generally used for increasing blood flow to the area and helping muscles and tendons to relax during chronic phases of injury – in other words, an injury that has been around for long periods.  By using heat, we are better able to relax tight muscles. Heat has been thought to increase the inflammatory process and thus is usually not advised during the acute phase (immediate post injury phase).

What cold treatments are available?

We may use the following cold treatment in practice: cold packs, gel packs, ice tape, compression units, menthol compounds and even vapo-collant spray.  One of the most common and arguably the best way to cool down an area is to use a baggie filled with ice/cold water.  Some individuals may use a bag of peas from the freezer – which will work as well.

What heat treatments are available?

Heat can be administered using a variety of ways including: hot packs, hydrocullator pads (we use this quite often in our practice), paraffin baths, whirlpools, and hot towels.  No matter which way is utilized, it is important to monitor the skin for inflammation via redness.  The main concern is that the individual may burn themselves if not monitored.

Before using heat or ice, always be sure to consult with your health provider.

Although, it may seems fairly simple, there is quite a bit of confusion out there when it comes to ice and heat.  Hope this post clears up some of the questions between heat and ice!

Dr. Luciano Di Loreto