New Thoughts on Ligament & Tendon Injuries
For decades we’ve been told RICE - Rest, Ice, Compression, Elevation is one of the basic tenets of sports injuries. But does it really help? In some instances it can be extremely appropriate, unfortunately these are pretty rare and severe situations like bone fractures and severe muscle trauma. The main concern when using RICE is to treat compartment syndrome - a condition where inflammation causes increased pressure in an area that can become quite dangerous. This is a very serious and painful condition which requires immediate medical attention, and in these cases inhibiting inflammation is helpful. But what about for everyday twists, sprains, and injuries involving ligaments and tendons? No, it's actually going to make it more difficult in the long run. Unlike muscles, ligaments and tendons do not have very much blood flow, and blood brings the healing properties to an injured area.
While it's true that icing will help with pain, because it numbs the area, it doesn’t actually help with healing at all. It stops inflammation by stopping blood flow, but like we said, increased blood flow is actually how the body heals. Check out this article if you want a deeper understanding of the inflammation process. When dealing with tendons and ligaments, we already have a limited about of blood, so using RICE will actually prolong recovery time. You can use it immediately after injury to help with the pain, but shortly after (48 hours or so) you’ll want to move to a different strategy that promotes healing rather than inhibits it. So what the hell am I supposed to do, you ask?!
The solution is MEAT: Movement, Exercise, Analgesics, Treatment.
Movement - we want to stimulate blood flow to the area, moving around and stretching up to pain tolerance will increase the flow of blood and fluid to the site of injury facilitating faster healing. Don't just let it sit there, this will lead to stagnation - the root of all illness in traditional Chinese medicine.
Exercise - we’re still stimulating blood and lymph fluids to come to the area with this one. The focus should be on eccentric exercises that load the joint and tendons with a little weight. Muscles turn from red to white (due to decreased vascularization/blood flow) as they turn into tendons and attach to the bone. Eccentric movements are when the muscle/tendon lengthens and strengthen the tendon end of the tissue, whereas concentric movements strengthen the muscle belly. Weight lifters know them negatives and it's basically the opposite of Don’t go for a 5k run, don’t max your deadlifts. Simple, stable and easy exercises are our focus. Here's a few good videos on our patient education page to get you started if you're still confused.
Analgesics - pain management is important, so let’s not throw it out the window. When you’re in pain, your body is stressed and its ability to heal is also inhibited. That being said, avoid NSAIDs, we want to let inflammation do its thing. Acupuncture, herbal medicine, contrast hydrotherapy, rest, these are all viable options. Even small amounts of tylenol are fine if that’s your jam.
Treatment - Here’s where a qualified medical professional will make sure you road to recovery is safe and effective. Whether it's acupuncture, physical therapy, massage, or whatever your favorite treatment is, make an appointment and get in to see your provider. But there are also some at home therapies you can do, especially contrast hydrotherapy. I cannot stress enough how powerful this therapy is for tendons and ligaments. The changing temperatures promote blood flow by expanding and contracting the tissues in the area. It's my go to for chronic ligament and tendon injuries. Do a cold wrap or ice bath for 1 minute for every hot wrap or bath of 3 minutes - generally about 4 times.
TLDR - RICE is good for a small amount of serious cases and for right after injury to reduce pain, but will prolong the healing in ligaments and tendons. MEAT enhances and promotes the bodies natural healing responses and gets you back in action faster.
Bret Kyle Rogers, L.Ac.
Texas based acupuncturist, qigong teacher, and herbalist demystifying Chinese medicine.