Promoting Broken Ankle Healing Using the RICE and MEAT Therapy Protocols
RICE is an acronym for REST, ICE, COMPRESSION and ELEVATION. This mnemonic dates back to the 1970s when a doctor came up with this prescription for healing that became the standard protocol to treat acute injuries.
RICE is an acronym for REST, ICE, COMPRESSION and ELEVATION and MEAT is an acronym for MOVEMENT, EXERCISE, ANALGESICS and THERAPY
More recent medical opinions suggest that both rest and ice can delay healing rather than promote it. Icing can reduce inflammation, and rest can promote joint rigidity, so movement without ice is suggested. The MEAT (MOVEMENT, EXERCISE, ANALGESICS and THERAPY) approach is considered particularly beneficial for ligament and tendon injuries. This all gets confusing when you deal with a trimalleolar fracture that compromises both bones and ligaments. What is the best approach if you have a combination of issues to resolve?
The therapists I work with, including the surgeon who fixed my ankle, suggest that therapy should include all of the above. So I created my own RICE and MEAT therapy that took from each approach the elements I felt were most beneficial, and eliminated those I did not want.
My daily dose of RICE and MEAT therapy to speed up healing my fractured ankle and get back to triathlon training
Just as rest is critical to repair from training, rest is necessary to heal an injury. In the more acute stages of my fracture I respected the healing process and did less. Each week I added more activity to my day but balanced that movement with a lot of rest.
I try to include at least an hour a day of non-device rest time, or a nap, to shut down and let my nervous system charge up. Even if I can’t nap, using some visualization to facilitate resting seems beneficial to my recovery.
There is some evidence that ice may delay recovery. The argument is that reducing swelling with ice prevents healing by decreasing the inflammation response. However, my objective is to regain joint mobility. Since I have an injury that is causing swelling in a joint, I need to reduce the swelling in order to allow the joint to move properly. Having the ability to move the joint further, I bring new blood back into the area. Although the ice may slow down the healing while it is applied, in my opinion the ability to create new movement patterns outweighs the short period of delayed repair. I alternate 20 minutes of mobility exercises with 20 minutes of ice. In this way, I feel like I am giving the joint the best chance to move through the greatest range of motion.
I invested in a motorized ice-cuff for my ankle which you can see at work in this video pumping ice water into a compression cuff around my foot. Applying ice and compression at the same time moves blood and fluid stuck at the joint out and allows new blood to come in. I believe using these therapies together has helped me to improve my ankle range faster.
High tech RICE therapy. This is a must-have item for injured triathletes but useful injured or not. The prehab benefit of icing/compressing your feet/Achilles is huge. It wasn't that expendy and there are a number of cuffs to squish other parts of your body if your shoulder/knee is the niggly part. I use it on/off whenever I am couch-bound alternating my PT @katelynbutton Rx ankle/toe/foot exercises with ice and compression to reduce swelling so I can do more range of motion when I move again. The high tech version of a bag of peas you might say. #cryocuff #brokenankle #ricetherapy #triathlon #injury #rehab #fracture #sprain #training
I also have some super cute compression socks from Asics that help keep swelling out of my ankle when I lift weights or move around. I use them when I move my ankle to control swelling as well. It has been suggested that compression socks will be helpful to support my ankle function when I return to running. I will let you know when I try it.
My version of elevation is the yoga legs up the wall pose. It allows me a nice restful position to visualize getting back in action and is perfect for allowing any blood stuck in my feet to flow back towards my heart. An added benefit is the amazing hamstring stretch I get out of the pose.
MOVEMENT AND EXERCISE
In addition to rest, I used MOVEMENT and EXERCISE the second day after surgery. For the first week I did about 60 minutes per day of strength training. The second week I did 90-120 minutes of strength training and 30-45 minutes hand cycling every second day (at first the hand cycling made my back and arms very tired). I think my body needs to move to heal. I felt so much better physically and mentally doing something active every day. I think it is logical: if strength training is good for bone health it must also be good for bone healing.
This is where the MEAT acronym lost me as I did not go this route. I read that Ibuprofin and NSAIDS can prevent bone healing so I avoided all pain medication and NSAIDS from the day after I left the hospital. This study agrees that there may be risk to taking NSAIDS with a bone injury:
“In the absence of robust clinical or scientific evidence, clinicians should treat NSAIDs as a risk factor for bone healing impairment, and their administration should be avoided in high-risk patients. (Scientific World Journal)
Once I read that I chose to not take any more medications. Fortunately, the pain and swelling of my ankle fracture was manageable without any so I was lucky.
I started therapy four days after surgery. I used an electric current bone healing machine that Jamie has at Synergy for the first three weeks. Once the first cast came off and I was in an Aircast I started PT with Kate Button. She started with a measurement of where we were starting from as you can see in the photo. I left the clinic with more than 10 degrees in both directions than when I stared. A-mazing! I also did ART with Jamie Grimes and I felt 100% better after my first treatment. I wasn’t even sure if anything could be done at that point but there was so much benefit to going and starting rehab early.
So there you have it, RICE and MEAT protocol, as prepared by me. I hope this is helpful! Stay positive, keep moving and listen to your body.