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  • Dr. Adrian Pujayana

RICE or METH? What's in your best interest?

Updated: Apr 2

Should you use ice, heat, or both? When is a good time to use RICE/METH protocol?

The difference between acute and chronic injuries depends on presentation and time. For example, chronic injuries typically are those aches and pains that have been ongoing for long periods, such as months or years. The intensity of chronic injuries can also change depending on activity or accidents that may cause a flare-up, in which case, that chronic injury experiences an acute presentation. As the name suggest, acute injuries present suddenly and with intensity, and continuous exposure to acute injuries can, at some point become chronic.

Depending on the presentation of symptoms, acute and chronic injury presentation can be managed effectively by following some guidelines...R.I.C.E. and M.E.T.H.! These are general guides for care, so please seek professional advice if you are un-responsive or slow to respond to self care. Here we go!


R.I.C.E. stands for Rest, Ice, Compression, and Elevation. Acute injuries have the characteristic swelling, pain, redness and loss of function, all of which R.I.C.E. can relieve. Additional steps like Protection and Stabilization can turn R.I.C.E. into P.R.I.C.E.S. which would also be appropriate for new injuries of flare-ups. Too much of R.I.C.E. can also work against you as well. Here’s how.

REST: Too little rest after an injury can worsen a condition or lead to new ones. Too much rest causes deconditioning and stiffening of body parts, leading to atrophy and further loss of strength. The right amount of rest allows an injured athlete subsequent return to play that is safe, predictable, and eventually to full capacity.

ICE: Ice constricts blood flow and helps reduce inflammatory reactions. But an ice pack that is too cold or placed too long on a body part will eventually be perceived as a threat to the body and cause unwanted inflammation! Just the opposite of the intended effect! Use ice sensibly, and use a tissue to protect the skin, no more than 10-15 continuous minutes depending on body part.

COMPRESSION: Too much compression constricts circulation and cause swelling and pain. Depending on the body part, compressive sleeves and bandages should be applied so that some movement is possible to the part of the body that is being compressed.

ELEVATION: Your body can only take so much elevation before other body parts become agitated. Changing positions regularly can prevent aches and pains from other body parts and make the process more tolerable.

M.E.T.H. stands for Mobilization, Elevation, Traction, and Heat. Chronic injuries typically respond well to these steps because of limited or absence of inflammation. Conditions that are chronic have characteristic stiffness and pain depending on activity, and like R.I.C.E., should be applied with sensibility.

MOBILIZATION: Gradual amounts of movement or assisted movements like in rehabilitative therapies can guide muscles and joints back to function. Staying active is a great way to mobilize your body, but staying within pain-free ranges of motion and pain-free intensity levels make this step highly effective.

ELEVATION: See above.

TRACTION: Muscles and joints like to elongate and have space between attachments. Assisted movements during physical therapies and exercises can induce temporary but therapeutic space between compressed joints. Of course, too aggressive or too much time under traction can overstretch connective tissues!

HEAT: When inflammation is under control, joints and muscles respond well to heat for its effect to enhance local circulation. Blood flow to an area in the right amount invites more oxygen and nutrients to healing tissues. Too much heat or too long of an exposure to hot packs can also induce inflammation! 20 continuous minutes of heat is adequate most of the time, so don’t fall asleep with your hot-pack on!

Accidents happen and injuries can come and go. Some injuries stick around way too long, and should be evaluated. But until then, being aware of your aches and pains and identifying its characteristics can help you decide which is best for you...RICE or METH!

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