M.E.A.T. vs RICE: A Better Way to Treat Sprains and Strains

If you grew up in sports, you probably learned RICE: Rest, Ice, Compression, Elevation. It was printed on posters in every athletic training room. It is still the first thing many parents and coaches reach for.

The science has moved on. This article explains what RICE was meant to do, why it fell out of favor, and what M.E.A.T. offers instead.

Where RICE came from

Dr. Gabe Mirkin introduced RICE in his 1978 Sportsmedicine Book. The idea was simple: calm the swelling and the pain, and the injury would heal faster.

In 2014, Mirkin publicly revised his position. He wrote that ice and complete rest may delay healing rather than help it. When the person who named the acronym walks it back, it is worth asking why.

What the research says about RICE

Two problems stand out.

Rest. Long periods of rest lead to stiffness, muscle loss and a weaker ankle or knee by the time the athlete is cleared. Guidelines for ankle sprains now favor functional treatment: early, protected movement and exercise instead of long immobilization (Vuurberg et al., 2018).

Ice. Cold reduces pain for a short time, but reviews have found little good evidence that it improves how well or how quickly soft tissue heals (Bleakley et al., 2004; van den Bekerom et al., 2012). Inflammation is not the enemy. It is the first stage of repair. Shutting it down may slow the process it is supposed to protect.

This is why I do not recommend ice as a treatment. It is still worth knowing RICE, because you will see it on exams and in older handouts, and you should be able to explain why practice has changed.

What M.E.A.T. stands for

M.E.A.T. is a movement-first framework for soft tissue injuries like sprains and strains.

M: Movement. Gentle, pain-free motion starts early. Moving the joint helps keep it from getting stiff and gives healing tissue the signal to line up along the lines of stress.
E: Exercise. Progressive loading rebuilds strength, balance and control. This is where the real return to sport is built.
A: Analgesia. Pain relief, as advised by your physician or pharmacist, so the athlete can move and do the exercise. The goal is comfort that allows movement, not masking pain to play.
T: Treatment. Hands-on care and a rehab plan from a qualified professional, such as an athletic trainer, physical therapist or physician.

Why movement-first makes sense

Ligaments, tendons and muscles adapt to the load you put on them. Tissue that is loaded gradually tends to heal stronger and more organized. Tissue that sits still tends to heal weaker and stiffer.

Other modern frameworks say the same thing in different words. PEACE and LOVE, published in the British Journal of Sports Medicine, calls for early protection, then load, optimism, blood flow through pain-free activity, and exercise (Dubois and Esculier, 2020). Different acronym, same message: protect early, then move and load.

What this looks like for a sprained ankle

Here is a simple picture of M.E.A.T. after a lateral ankle sprain. Your athletic trainer will set the details.

Day 1 to a few days: protect the ankle, use compression for swelling, and start pain-free ankle motion such as ankle circles or tracing the alphabet with the toes.
As walking improves: walk without a limp, add calf raises and balance on the injured leg.
Building up: hops, then single-leg hops, then cutting drills.
Return: full sport drills with no pain, no giving way and no swelling the next day.

For more on the return-to-play tests, read Ankle Sprain Return to Play.

When M.E.A.T. is not the answer

Movement-first care is for typical sprains and strains. It is not for:

Suspected fractures. Use the Ottawa Ankle Rules and get imaging when they say to.
Dislocations, major deformity or a joint that will not bear weight.
Signs of nerve or blood flow problems, like numbness, a cold foot or color changes.
Head and neck injuries.

In those cases, stop and get the athlete evaluated.

A note for students

RICE, PRICE, POLICE, PEACE and LOVE, and M.E.A.T. all show up in athletic training courses. Know what each letter stands for, but more importantly, know the reasoning: early protected movement and progressive load beat long rest. Rehab principles like these are covered in depth in Rehabilitation Techniques, Athletic Training Ch. 11.

Studying for the BOC? Test yourself with the free BOC practice quiz.

Common questions

Should I keep it completely still for a few days? Protect it, but do not freeze it. Short-term protection with a brace or tape is fine. Complete rest for a long stretch is what we are trying to avoid.

Is swelling bad? Some swelling is a normal part of healing. Compression and gentle movement help manage it. Large, fast swelling after an injury is a reason to get evaluated.

Can I play through pain if I take something for it? No. Analgesia in M.E.A.T. is there to let you move and do your rehab, not to get you back on the field before the tests say you are ready.

How do I know when to progress? Move to the next step when the current one is pain-free, controlled and does not cause more swelling the next day.

The short version

RICE was built on good intentions. Its creator has since revised it.
Rest and ice may slow healing more than they help.
M.E.A.T.: Movement, Exercise, Analgesia, Treatment.
Protect early, then move and load. Get serious injuries evaluated.

Jena K Phillips, LAT

This article is for education and does not replace an evaluation by a licensed health care provider.

Sources

Mirkin G, Hoffman M. The Sportsmedicine Book. Little, Brown; 1978.
Mirkin G. Why ice delays recovery. DrMirkin.com, 2014 (updated). https://drmirkin.com/?p=421
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251-261.
van den Bekerom MPJ, Struijs PAA, Blankevoort L, et al. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012;47(4):435-443.
Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.
Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73.

This guide is general education, not medical advice, and it does not replace a visit with your own doctor, athletic trainer or physical therapist. If you have pain that is severe, getting worse, or not improving, please get checked.