Is RICE Really the Best Option After an Ankle Sprain?
Chatham-Kent Physiotherapy, is RICE really the best option after an ankle sprain?
For years, we’ve heard that immediately after an ankle sprain it’s best to start a RICE (or PRICE) approach to early management. The common acronym refers to Protect, Rest, Ice, Compression, and Elevation. But is that really best practice?
A better approach is following the POLICE principles by Protecting, Optimal Loading, Ice, Compression, and Elevation.
Protection includes intervention such as bracing and athletic taping and should be used for a short period immediately after the injury. In this short period of time, bracing and taping should function to unload and/or prevent joint movement for a short period. Beyond this acute phase, bracing and taping can be used to allow safe and pain-free participation in rehabilitation exercises and are effective at preventing recurrent lateral ankle sprains. However, in the long term, an ankle brace is more cost-effective than taping. (Check out the link to our favourite ankle brace we use for patients!).
Optimal Loading means replacing rest with an individualized and incremental rehabilitation program where early movement promotes faster recovery. A loading approach should include comfortable, progressive load with home exercises, functional activity, and manual therapies. Multiple sessions of manual therapy (joint mobilizations) have been shown to improve functional outcomes in patients with lateral ankle sprains and a number of studies have shown that early balance retraining can reduce the risk of ankle sprains in athletes by half. In one study, 54% of patients instructed on early weight bearing returned back to full function versus 13% of the patients who were immobilized for 10 days after a mild (grade 1-2) lateral ankle sprain.
Ice has historically been thought to reduce inflammation, however, there is not a single study to date that supports the use of ice other than for its temporary numbing effect on the skin. Pain control is the benefit of icing after an acute ankle sprain. In theory, if icing slows blood flow to an injured area, it should also reduce inflammation. But… all of our body’s nutrients and healing chemicals are in our blood, so why would we want to limit blood flow to an injured area? If you’re taking anti-inflammatories, that may also come with some drawbacks. Certain studies have shown that anti-inflammatories following ankle sprains reduce pain and promote earlier return to function, but increase the reinjury rate long term.
Compression is an area with limited research. The majority of the rationale is taken from research in compression’s role in regulating blood and lymphatic flow. Tying back to Optimal Loading, compression combined with active movement and functional exercise will further improve blood and lymphatic flow.
Elevation also does not have large amounts of research to support its benefit, however, can be used to control achy or throbbing pain and regulate blood flow to the injured area. By elevating the injured limb, the flow of blood from the injured area is assisted by gravity, helping sweep some of the stagnant cells away from the area. Again, combining elevation and active movement of the injured area will further improve blood and lymphatic flow.
Of course, it’s always important to use an individualized rehabilitation approach since no 2 injuries are the same. If you’ve had a sprain or strain and are wondering what is best for you, give us a call at 519-358-7342 to book an assessment with one of our physiotherapists or chiropractor!
Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE?. Br J Sports Med. 2012;46(4):220-221.
Eiff MP, Smith AT, Smith GE. Early mobilization versus immobilization in the treatment of lateral ankle sprains. Am J Sports Med. 1994;22:83-88.
Green T. Refshauge K, Crosbie J, Adams R. A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains. Phys Ther. 2001;81(4):984-994.
McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103-1111.
Omstead LC, Vela LI, Denegar CR, Hertel J. Prophylactic ankle taping and bracing: a numbers-needed-to-treat and cost-benefit analysis. J Athl Train. 2004;39(1):95-100.