This post is food for thought, more specifically MEAT for thought. Yes, MEAT, another protocol for acute injury management.
I talked in other blog posts about different protocols to manage acute injuries: RICE, PRICE and POLICE. Also, I talked about HARM, which advises you what to avoid when injured.
POLICE is generally accepted as the best, however there are more ideas out there and, as there is not much strong evidence about any of the protocols, I thought I should write about other options as well. I explained to you in a previous post why the “R for rest” in RICE and PRICE is not a good idea when having an acute injury and that’s why these two protocols are not used much by health professionals (maybe they are still used by some who aren’t keen on research). Can’t you remember this? Yes? I told you that rest might be harmful (weakness, stiffness, reduced proprioception, recovery inhibition, etc.) However, early mobilization and functional rehabilitation with early weight-bearing, usually with protection, are more effective than immobilization and total rest and that’s why POLICE is used now (“OP” stands for “optimal loading” which means replacing rest with a rehabilitation programme). Have a look at these papers which compare immobilization with functional treatment:Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults by Gino MMJ Kerkhoffs et al., Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial by Chris M Bleakley et al. y Acute treatment of inversion ankle sprains: immobilization versus functional treatment by Jones MH et al.
For all the above-mentioned reasons, POLICE is the protocol I am going to compare with MEAT.
While the well-known POLICE (this last one is currently the most used protocol) is thought to the best option for any acute injury by the majority of health professionals, some of them disagree and state that this protocol works well for acute muscle injuries, but it doesn’t work as well for acute tendon and ligament injuries. Why is this?
It is suggested that the POLICE protocol could inhibit healing and therefore delay recovery in those with an acute tendon or ligament injury. To be fair, just the “ICE” (“I” for ice, “C” for compression and the “E” for elevation) would be the problem, as it decreases blood flow. Here is where MEAT makes its appearance to focus on increasing blood flow and getting rid of ice, compression and elevation, which are thought to be harmful when treating ligament or tendon injuries.
Well, apparently, for muscle injuries it is recommended to perform the POLICE protocol because blood supply in muscles is rich, so reduced blood supply is not a problem when muscles get injured and, also, you are always at risk of having compartment syndrome if you don’t do so. Compartment syndrome occurs when pressure increases in a muscle compartment, which is a space that contains muscles, nerves and blood vessels. This compartment is covered by fascia whose role is to keep the tissues in place. Because the fascia does not stretch when swelling or bleeding occurs, this can cause increased pressure on the capillaries, nerves, and muscles in the compartment, decreasing blood flow, which prevents nourishment and oxygen from reaching the area. This vicious cycle can lead to permanent muscle, nerve or circulation damage. That’s why POLICE would be a good protocol to manage acute muscle injuries.
On the other hand, ligaments and tendons have reduced blood supply and, therefore, poor nutrient supply. This means that it is more difficult for them to heal. So, if you apply the POLICE protocol, ice, compression and elevation might reduce even more the blood supply and, thus, delay healing or not heal completely. Some tendon and ligament injuries could become chronic for this reason.
Let’s start talking about MEAT:
What does MEAT stand for?
M for movement:
It is thought that early movement of the affected area stimulates healing, reduces the formation of inappropriately aligned collagen fibres (scar tissue), and improves recovery.
E for exercise:
For the same reasons as movement, exercise is very important in early stages. Also, something I didn’t comment about before, exercise therapy is thought to be effective in reducing the risk of recurrent sprains after acute ankle sprain, as you can see in Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: A systematic review de Philip J van der Wees et al. This might be similar for other acute ligament injuries as well.
A for analgesics:
Natural analgesics are recommended, as long as you don’t take anti-inflammatory medication which will inhibit the process of healing, as I have told you several times in other blog posts.
T for treatment:
This refers to any kind of physiotherapy treatment which could increase blood flow and, therefore, stimulate healing.
Check out this study Effect of accelerated rehabilitation after ankle sprain function: randomized controlled trial by Chris M Bleakley et al. (BMJ 2010; 340: c1964), which compares protection, ice, compression and elevation to early therapeutic exercise.
My thoughts about MEAT
I would say that all this makes sense to me, don’t you think so? Although, I think that MEAT has too many letters. Aren’t movement and exercise the same thing? Also, couldn’t these two be part of the treatment?
What this protocol wants to convey is the importance of increasing blood flow to stimulate recovery in ligament and tendon injuries (remember that it is not the same for muscles). Also, I have read in some papers that heat is recommended to increase blood flow. I am not sure if my patients would be happy applying a heat pack on a swollen ankle though.
So, we get rid of ice, compression and elevation because they decrease blood flow, but what about “POL” (“P” for protection and “OL” for optimal loading)?
The reality is that optimal loading, movement and exercise are the same thing and protection can’t be bad, that’s for sure.
Why don’t you use “hot/cold immersion therapy” or contrast bath (have a look at this post in the section about ice). This method acts as a pump, therefore, it increases blood flow. It is supposed to be used 72 hours after getting injured, but this is the choice with my patients even immediately after injury. Based on what? Experience. It works well with my patients and they are happy with it, so why not?
In summary, do what works for you. My opinion is that you should be clear what kind of injury you have (muscle, ligament or tendon injury) and then decide which is the best protocol for it. POLICE seems to be a good choice for muscle injuries and I would say that a mixture of POLICE and MEAT for ligament and tendon injuries should be all right
Let’s call this mixed protocol POLAT ( “P” for protection, “OL” for optimal loading -which includes movement and exercise-, “A” for analgesics and “T” for treatment). Hmmm…it might be difficult to remember. It is a Turkish surname, but not many people know this.
Ok, I have the solution, let’s call it the PAT protocol, yes!! I think this is the “appropriate” protocol: “P” for protection, “A” for analgesics and “T” for treatment which includes movement, exercise and any other type of treatment that stimulates healing. I just made it up, but it doesn’t sound too bad.
“Any idea about how to manage acute injuries?” Share your thoughts by writing a comment.
If you want to learn this post in Spanish, follow this link MEAT.
If you have any questions, do not hesitate to contact me on The Physical Therapy, Physiotherapy Clinic based in Southampton, and I will be happy to help you.