A new recommendation for faster soft tissue recovery, MCE; Movement, compression, and elevation

I’m sure by this point almost everyone is familiar with the RICE acronym; rest, ice, compression, and elevation. This has been used to manage the inflammatory response during acute injuries for I don’t even know how long, a long time though. There are three stages to healing musculoskeletal injuries in the body, inflammation, repair, and remodelling. Popular opinion is that icing will act to limit the amount of inflammation during the initial healing phase, which is beneficial because the injured area gets too much inflammation. This can cause damage to surrounding tissues and increase the time frame of the first stage, delaying the next two phases of injury healing.

A new movement is telling people to throw away their ice packs, suggesting that your body’s inflammatory response is not a mistake. Stating that icing could potentially cause more pain and congestion in the injured area, due to the increase in permeability of lymphatic vessels caused by ice. This increase in permeability causes the fluids that should be carried back into the cardiovascular system to be poured in the wrong direction, back into the injured area. Another key point is the realization that the actual inflammation is not the problem, but rather the evacuation of the waste at the end of the inflammatory phase.

Because of this, the new recommendation for faster recovery is MCE; Movement, compression, and elevation. By using this acronym you don’t interrupt the body’s inflammatory response, instead you support its adaptation abilities by improving circulation and ridding the area of the congestion. Which in turn will facilitate healing; waste out, nourishment in.

Here’s how it works. Movement of the injured area produces a pump like effect, the muscle contractions stimulate the lymph system which will carry away the congestion or waste materials. These contractions not only push congestion through the lymph system, it also creates a negative pressure which ‘pulls’ the congestion away from the injury site.

You may be wondering how this can work when you often can’t move the injured area. This is when a muscle stimulator becomes very useful. Devices like the Marc Pro use the principle of muscle contraction to move nourishment and waste in the appropriate direction and place, without you having to manually move the injured soft tissue. Compression and elevation remain for the same reasons as the original RICE protocol. Manually compressing or using a compression band can be used as a secondary mechanism, along with elevation to continue to remove waste away from the injury site.

Icing is still helpful for pain management as a short term goal so you don’t necessarily have to throw your ice packs away. The non-icing model for healing is definitely an interesting idea and is being used by many with great results!

-Patrick

“Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” JEM, 2008; Feb. 25; 65–68

” The use of Cryotherapy in Sports Injuries”, Sports Medicine, Vol. 3. pp. 398-414, 1986