PRICE method vs METH methods: Therapy Treatment of Inflammation for Soft Tissue Injuries. Which is better?
image shot at Aro Ha
If inflammation is a normal human physiological process for the healing response why do we ice acute soft tissue injuries to stop inflammation?
A brief review: Inflammation is the 2nd phase of the healing process (Hemostasis, Inflammation, Proliferation, Remodeling). The goal of inflammation is to increase circulation to the site by increasing vasodilation, increasing angiogenesis (formation of new blood vessels) as well as recruiting the immune system, and initiating the healing sequence.
The use of ice to reduce inflammation is also known as the modality of cryotherapy. Some of the goals of cryotherapy (the use of ice or heat extraction) are to cause vasoconstriction, increase viscosity, and decrease tissue metabolism.
Is it just me or is this a blatant contradiction of each other? The real question then becomes according to the research do we want vasoconstriction or vasodilation with acute soft tissue injuries?
For years people have been just applying the gold standard "P.R.I.C.E." principle as that is what was called for. But does the research support this? for those that do not know the "P.R.I.C.E." principle is:
P.R.I.C.E. Principle- Protect, Rest, Ice, Compress, Elevate
Despite the common application of cryotherapy, the evidence for its usage is lacking in the research. Doing some research I found a research article that put the concept well. "It is apparent from the references cited that a great deal of confusion exists with respect to utilization of cryotherapy and the parameters for the application of cold modalities. From this perspective, one might question whether clinicians are practicing according to evidence (or the lack thereof) or if decisions are being made based on historical factors, such as therapeutic modality availability, ease of application, familiarity with a given modality, and tradition." (S. Hawkins referenced below)
While studying for a Modalities test and an Integumentary test in PT school I thought of this discrepancy so I decided to do a little more research. I found an interesting article about the "M.E.T.H" Principle (by a Toronto-based trainer and exercise physiologist, John Paul Catanzaro) that makes some sense but might need some further research. The "M.E.T.H" Principle is:
M.E.T.H. Principle - Movement, Elevate, Traction, Heat.
The argument for the M.E.T.H. Principle is that ice vasoconstrics and reduce the amount of blood reaching the injury thus slowing down circulation and the healing process.
Dr Di Loreto puts it well at the end of the article, "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."
She does not say that the P.R.I.C.E Principle is always wrong but it does have its time and place but we should also consider the M.E.T.H. principle to have another tool in our toolbox.
References:
Ham, RL. Text and Atlas of Wound Diagnosis and Treatment. New York, NY:McGraw-HillEducation; 2015.
SussmanC, Bates-Jensen B. Wound Care: A Collaborative Practice Manual for Health Professionals, 4thed. Baltimore, MD:LippincottWilliams & Wilkins; 2012.
MichlovitzS, BellewJ, Nolan T. Modalities for Therapeutic Intervention. 6thed. Philadelphia, PA: F.A. Davis Company; 2016. ISBN: 978-0-8036-4563-9 Chapter 2
Di Loreto L. METH versus RICE. Fit for Life | Vaughan Chiropractor Physiotherapy. https://www.fitforlifewellnessclinic.com/rice-versus-meth-a-new-approach-for-healing-soft-tissue-injuries/. Published July 14, 2014. Accessed February 25, 2018.
Hawkins SW, Hawkins JR. CLINICAL APPLICATIONS OF CRYOTHERAPY AMONG SPORTS PHYSICAL THERAPISTS. International Journal of Sports Physical Therapy. 2011;11(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739043/. Accessed February 25, 2018.