The prevailing
theory on how to treat sprains and strains, especially from exercise, has been
to follow the R.I.C.E. sequence – rest, ice, compression, and elevation.
اضافة اعلان
While the
method is still widely recommended and observed, some sports medicine
physicians, including the one who coined the acronym R.I.C.E., are shifting
their guidance: Movement, rather than rest, can better aid in recovery in some
cases, and icing is not always the most effective treatment.
Injured? Try
moving instead
Dr. Gabe
Mirkin, a retired sports medicine physician who in 1978 coined the term, said
he no longer advises following that protocol because of evidence that, for some
injuries, rest and ice delay healing, rather than aid it.
He now
recommends early movement after an injury, as long as patients are not in pain,
especially for overuse injuries.
“The most
important rule is to listen to your body because you feel pain when you’re
doing something wrong.” Dr. Mirkin said. “The reason injuries are so common is
that people think they can work through pain.”
Updated
approaches are incorporated into the (awkwardly named) acronyms “M.E.T.H.” –
movement, elevation, traction, and heat – or “P.O.L.I.C.E.,” protection,
optimal loading, ice, comprehension, and elevation.
When should you
ice, and when should you heat?
While many
clinics and healthcare providers, including Britain’s National Health Service,
recommend applying ice to the injury for 20 minutes every two to three hours
after an injury, scientific studies on the effectiveness of ice have been
inconclusive.
Dr. Julie Han,
a sports medicine physician at NYU Langone Health, said there was no right or
wrong answer on whether to use heat or ice, and emphasized that neither would
cure an injury.
“It’s not going
to fix anything, it’s not going to impede your progress if you choose one over
the other,” she said. “They’re essentially techniques that could be helpful in
alleviating symptoms.”
Typically, to
reduce pain caused by acute injuries, she recommended icing for the first week
or two when the injury is swollen or bruised and then switch over to heat
therapy to relax and warm up the muscle if there is stiffness. However, there
is no hard-and-fast rule, she said.
“Choose what
feels better for you,” Dr. Han said. Nonsteroidal anti-inflammatory
medications, like ibuprofen, and physical therapy are most effective
treatments, she added.
Corey Kunzer, a
doctor of physical therapy at the Mayo Clinic in Rochester said he typically
recommended ice at the initial onset of an injury to help with the pain, and
that both ice and heat can be helpful. He tends to recommend heat in the
morning, when muscles may be stiffer, and ice in the evening.
Ice is the
“safest pain medicine available today,” Dr. Mirkin said. But it also reduces
inflammation, which is needed for healing, he added.
He said, “You
want some of that swelling and inflammation because that is what some of the
healing process happens with,” he said. “At the same time, you want too much
because it can be painful.”
The argument in
favor of movement over rest
Over his nearly
two decades in physical therapy, Mr. Kunzer said that recommendations have
shifted away from immobilization and toward early movement. “You want to walk
that tightrope, that fine line between getting that motion, but also still
protecting it,” he said of the injured muscle.
While moving
too quickly after an injury can prolong the pain, too much rest can cause
stiffening and further loss of strength. He tells patients that exercise is the
best medicine and uses the phrase “motion is lotion” to encourage patients to
keep moving, particularly when they have conditions like osteoarthritis.
“Be as active
as you can for as long as you can, with whatever activities bring you joy,” he
said.
The best
treatment approach depends on the injury
The method of
recovery that is most appropriate depends on the type of injury, its severity,
and its location. While many strains heal on their own within a few weeks, more
severe one may need to be immobilized in a cast or may require surgery.
The bottom
line: If an injury is serious, seek recommendations from a doctor as soon as
possible for advice on treatment. Understanding the cause of your pain, through
a professional diagnosis, can help determine whether it is safe to keep moving
or whether rest is required for healing.
Injuries occur
when people add too much to their exercise regimen too quickly, so it is
important to build intensity, frequency, and duration gradually. As you get older,
warming up and cooling down is even more important. Eating a balanced diet and
getting enough sleep are good ways to stay healthy and prevent future injuries.
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