Explore the effectiveness of the RICE method for treating ankle sprains with Meri Sehat. Learn proper care for a speedy recovery.

RICE For Ankle Sprain – Does It Work?

Ankle joint injuries are among the most frequent musculoskeletal ailments.

Introduction

Ankle joint injuries are among the most frequent musculoskeletal ailments. These injuries cause about 10% of all injuries treated in the casualty department. Athletes, in particular, are the most vulnerable population with ankle ligament sprains occurring between 11% and 20% of all the time they&rsquo;re injured<a href="#accordion">[1]</a>. 
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Since ankle inversion is the most frequent mechanism of injury, it goes without saying that the lateral ligament is more frequently damaged than the medial one. It&rsquo;s important to get timely treatment, otherwise injuries to the soft tissue structures around the ankle can have long-term effects. Timely treatment helps determine how soon a person with a sprained ankle can return to work and sports, or whether these injuries have caused a permanent loss of function. 
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Understanding RICE treatment for Ankle Sprain

The first thing that a healthcare provider will do as part of management during the acute phase of treatment is to get a complete picture of the damage to rule out the probability of any serious injury such as a fracture at the site of trauma.

If there are no fractures, then R.I.C.E. (an acronym for Rest, Ice, Compression, and Elevation) is recommended by the majority of current guidelines. Let&#39;s explore RICE. 
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<h5>Step1: Rest</h5>

Rest is advised in order to stop further tissue damage. It&rsquo;s advised to rest for at least 24-48 hours or until it&rsquo;s possible to use the injured limb without pain. 
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<h5>Step2: Ice</h5>

Ice is believed to<a href="#accordion">[9]</a>.

<ol>
	<li>Decrease nerve conduction</li>
	<li>Decrease muscle spasm</li>
	<li>Have an antinociceptive effect on the gate control system&nbsp;</li>
</ol>

Additionally, ice has been demonstrated to lessen pain sensitivity, <a href="https://merisehat.pk/disease/edema">edema</a>, and inflammatory response<a href="#accordion">[9]</a>. It also limits cell death and hemorrhage<a href="#accordion">[10]</a>. 
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Please Note: Use a cooling pack or wrap ice cubes in a thick clean cloth and then gently place it on the injured area for a maximum of 15 to 20 minutes. Repeat this four to eight times a day for the initial 48 hours or till the swelling is reduced. Be careful not to use ice directly on skin and neither to use the ice packs for too long as this could result in tissue damage.&nbsp; 
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<h5>Step3: Compression</h5>

Compression is supposed to raise the interstitial fluid&#39;s hydrostatic pressure in order to reduce the force that causes fluid to leak out of damaged tissue. Consequently, compression reduces the secondary tissue damage that frequently results after injury. Compression can be done using an elastic bandage or wrap. 
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<h5>Step4: Elevation</h5>

Elevating the injured limb makes use of gravity&#39;s pulling power. It causes a decrease in edema, an increase in venous and lymphatic drainage, and a decrease in local bleeding. 
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RICE therapy should be started as soon as feasible after an injury<a href="#accordion">[11]</a>:

<ol>
	<li>
	<h5>Rest</h5>
	</li>
</ol>

Limit your activity as much as you can. Avoid using the damaged body part and protect it from further harm. Even if it&rsquo;s just moderate pain, there&rsquo;s no need to rush it as that can delay recovery or, worse, aggravate it. Use mobility aids like a walker or a cane during this time. 
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<ol start="2">
	<li>
	<h5>Ice</h5>
	</li>
</ol>

Apply an ice pack to minimize discomfort and swelling. If there&rsquo;s no ice pack, a bag of ice or frozen peas, for instance, can also work. Make sure that the ice pack is covered with a cloth or towel as direct contact can cause frostbite or ice burn. For the first 2-3 days, ice the affected spot for 20 minutes at a stretch. Repeat the process several times each day; just ensure that the skin is warm before icing the injury again. 
&nbsp;

<ol start="3">
	<li>
	<h5>Compression</h5>
	</li>
</ol>

Wrap an elastic bandage or an Ace bandage around the affected region. It should be firm but not too tight to cut off blood flow entirely. If there&rsquo;s swelling, increasing pain, tingling, or numbness at the injured area, loosen the bandage. Depending on the intensity of the injury, the healthcare provider can also suggest splints or special boots to help reduce the swelling. As a precautionary measure, it&rsquo;s usually advised to keep the compression for 2-3 days. 
&nbsp;

<ol start="4">
	<li>
	<h5>Elevation</h5>
	</li>
</ol>

The idea here is to raise the injured ankle to or above the heart level whenever possible.&nbsp; This can be achieved by using pillows, for instance. The purpose is to prevent any additional swelling so, when seated or lying down, it&rsquo;s best to keep the leg in an elevated position for 2-3 hours a day. RICE advocates advice switching to heat once the swelling has decreased. Consult a doctor if you require a wrap for more than three days. You could be seriously hurt.

It&rsquo;s easy to assume that there is a lot of evidence in favor of this strategy because it is promoted so frequently. There is not; despite its popularity, there is not enough data to prove that the RICE method is effective in treating sprained ankles<a href="#accordion">[4]</a>. 
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The major goals of RICE are to alleviate pain and inflammation and to aid in the healing of the injury. RICE does, in fact, relieve pain and inflammation.

<ul>
	<li>Resting means there&rsquo;s no unnecessary activity that can trigger additional pain.</li>
	<li>Ice numbs the affected area.</li>
	<li>Compression and elevation reduce swelling. 
	&nbsp;</li>
</ul>

The evidence for utilizing RICE, particularly the ice component, is uncertain. 
&nbsp;

<ol>
	<li>
	<h5>Reducing Blood Flow</h5>
	</li>
</ol>

Blood flow is required for healing. Our bodies must disassemble damaged cells and reconstruct those using raw ingredients. The entire procedure may take longer if sufficient blood flow is not maintained.

Blood flow must be regulated, not slowed down, for healing. That makes the body&#39;s healing process far more effective. Each RICE step has the potential to reduce blood flow.

For instance, contrary to the fact that blood flow is promoted by motion, RICE suggests keeping the injured part of the body stationary, which naturally results in restricted flow. Also, when ice is applied to the body, the body&rsquo;s defense mechanism causes the blood vessels to constrict, thereby decreasing blood flow to the skin. Moreover, if the blood arteries are compressed, it&rsquo;s difficult for more blood to reach the affected area.

It&#39;s possible that the wound will heal faster if the blood flow is not restricted in any way. 
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<ol start="2">
	<li>
	<h5>Joint Stiffness</h5>
	</li>
</ol>

According to the available data, healing is improved by moderate movement rather than total rest.

Inactivity, as stressed by the RICE treatment, can cause stiffness and tissue atrophy. This means it will take more time for that ankle sprain to heal because the body is regaining its strength and muscle tone.

On the other hand, exercise will increase blood flow and produce chemicals that strengthen, repair, and maintain the tissues.

Note:&nbsp;Fractures require complete rest. Always follow the doctor&rsquo;s advice in case of an injury. 
&nbsp;

<ol start="3">
	<li>
	<h5>Ice Burn</h5>
	</li>
</ol>

An ice burn can occur through excessive icing or applying a cold pack directly on the skin (frostbite). It&rsquo;s easy to identify: the skin turns pale or red and also feels tingly. When that happens, immediately cease icing and let the skin warm up.

Always follow the rules of icing: wrap the ice pack in a towel or other layer of cloth; don&rsquo;t ice for more than 20 minutes at one time; and allow the tissues to warm before icing the spot again<a href="#accordion">[11]</a>. 
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In addition to the RICE treatment, some doctors advise taking nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen. Both over-the-counter and prescription options are offered for these. However, it&rsquo;s important to discuss the medical history before using any medications. 
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Conclusion

The typical RICE treatment approach restricts blood flow to soft tissue injuries. As a result, the healing process can slow down. While scientific evidence supports the idea that heat and activity are actually more beneficial for healing than ice and rest, RICE is still highly recommended by many medical professionals. It&rsquo;s best to discuss this treatment option for pain and rehabilitation with a healthcare provider first. 
&nbsp;

Key Takeaways

<ul>
	<li>Ankle sprains count for nearly 10% of all injuries treated in the casualty department.</li>
	<li>If not treated properly, these injuries can have long-term effects and influence how soon the person returns to work and sports.</li>
	<li>While scientific evidence supports the idea that heat and activity are actually more beneficial for healing than ice and rest, RICE is still highly recommended by many medical professionals.</li>
	<li>It&rsquo;s best to discuss this treatment option for pain and rehabilitation with a healthcare provider first. 
	&nbsp;</li>
</ul>

[1] bLopes J, Reid DA. Comparison of multimodal physiotherapy and" RICE" self-treatment for early management of ankle sprains. New Zeal J Physiother. 1980;13.

[2] Bleakley CM, McDonough SM, MacAuley DC. Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med. 2006;40(8):700–5.

[3] Chien AJ, Jacobson JA, Jamadar DA, Brigido MK, Femino JE, Hayes CW. Imaging appearances of lateral ankle ligament reconstruction. Radiographics. 2004;24(4):999–1008.

[4] Järvinen TAH, Järvinen M, Kalimo H. Regeneration of injured skeletal muscle after the injury. Muscles Ligaments Tendons J. 2013;3(4):337.

[5] Miyakawa M, Kawashima M, Haba D, Sugiyama M, Taniguchi K, Arakawa T. Inhibition of the migration of MCP-1 positive cells by icing applied soon after crush injury to rat skeletal muscle. Acta Histochem. 2020;122(3):151511.

[6] Tseng C-Y, Lee J-P, Tsai Y-S, Lee S-D, Kao C-L, Liu T-C, et al. Topical cooling (icing)

[7] Hotfiel T, Seil R, Bily W, Bloch W, Gokeler A, Krifter RM, et al. Nonoperative treatment of muscle injuries-recommendations from the GOTS expert meeting. J Exp Orthop. 2018;5(1):1–11.

[8] Lee S, Rosenbaum D. TdT Negative T-ALL. West J Med. 1981;134(2):168.

[9] Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage. 1994 Jan;9(1):56-9. doi: 10.1016/0885-3924(94)90150-3. PMID: 8169463.

[10] Ho SS, Coel MN, Kagawa R, Richardson AB. The effects of ice on blood flow and bone metabolism in knees. Am J Sports Med. 1994 Jul-Aug;22(4):537-40. doi: 10.1177/036354659402200417. PMID: 7943521.

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