If you twist or sprain your ankle, you know what to do: rest, ice, compression, and elevation, aka the RICE method.
Not so fast. Although athletic trainers and orthopedists have been preaching RICE treatment for years, it turns out there may be insufficient evidence to support this approach — and good reasons to try something new.
What Is the RICE Method for Injury?
In the event of an injury — such as an ankle, wrist, or knee sprain — health practitioners have long recommended a treatment protocol consisting of the following:
- Rest: Immobilize the affected area to prevent exacerbating the injury.
- Ice: Apply something cold to the injury to reduce pain and swelling.
- Compression: Introduce pressure to the affected area to further limit swelling.
- Elevation: Raise the affected area above heart level, also to minimize swelling.
The RICE method stood largely unquestioned for decades, but a recent study may force a rethinking of the acronym.
Problems With RICE Treatment
Sprained ankles are the common cold of orthopedics. Some 28,000 people sprain their ankles every day in the U.S., usually on the outside of the joint; it’s an injury where the ankle turns inward on impact. Yet if not treated properly, 30 to 40 percent of patients with these injuries can endure persistent problems.
Researchers are now blaming some of those persistent problems on immobilization. “The idea of complete rest used to dominate all of orthopedic medicine,” says orthopedic certified specialist Eric Robertson, PT, DPT, director of Kaiser Permanente Northern California Graduate Physical Therapy Education in Union City, California. “Whether it was back pain or an ACL tear, you’d be in a body or leg cast for 6 weeks.”
Research now suggests that a lengthy period of rest can have negative consequences. When injury occurs to the ligaments, the body lays down scar tissue in a cross-hatch pattern instead of the normal parallel pattern, and that can create weakness, Robertson says. Realignment of these fibers is achieved through use of the tissue, explaining why those who immobilize an injury are apt to reinjure the affected area. For that reason, he says, “We cringe when we see people with ankle sprains in a walking boot.”
Injuring the ligaments that support the ankle also contributes to problems with balance. “If you stay off that foot, it can propagate that,” Robertson says. “The earlier you can get on the leg and move it in a carefully controlled manner, the better it’s going to do. Tissue tends to respond positively to force. The point is to get on the foot right away.”
A 2012 review study gave early movement a thumbs-up. It found that people who followed early mobilization — some during the first week after an ankle sprain — enjoyed a shorter recovery period and better range of motion than those adhering to the standard RICE protocol.
The practice of icing injuries has also come into question. Some data indicates that the use of ice on damaged muscle may actually delay healing. But the jury is still out. Since cold therapy may help with pain and reduce swelling, some experts recommend it based on the idea that people can start moving an injured area more quickly if it hurts less.
Elevation and compression have been studied less, but they don’t seem to be harmful. Both practices seem to reduce the swelling of inflamed tissues, and may therefore make movement easier, which can speed healing.
Forget the RICE Method for Injury – Call in the POLICE
So what to do if you hurt your ankle, knee, or wrist? First, make sure the pain signifies a sprain and not something more serious. “If you can’t bear any weight on it, have extreme tenderness, rapid swelling or visible deformities, get it checked out,” Robertson says. In these cases, go to the ER or urgent care.
If the problem isn’t a fracture, your best bet is a new treatment acronym, called POLICE (for protection, optimal loading, ice, compression, and elevation). A visit with a physical therapist can show you the right way to move your foot to improve healing and protect it from further injury.
A therapist may also suggest balance exercises, which can help reduce the chance of future sprains. “There are predictable patterns of weakness,” Robertson says. “We can give you exercises to help.”
Manipulation of the affected area is another treatment a therapist may apply. “There’s evidence that moving the joint around just after a sprain can be really helpful in healing,” Robertson says.
With your physician’s approval, you can also take a non-steroidal anti-inflammatory medication, such as ibuprofen (e.g., Motrin, Advil) or naproxen sodium (Aleve), during the first day or two after a sprain to relieve pain. But since these medications can potentially impede healing by suppressing inflammation — and can hurt your gastrointestinal tract — switching to acetaminophen is recommended if you’re still suffering after 48 hours.
“If you take a holistic approach, loading the joint quickly in a progressive manner and using ice intermittently [under a therapist’s supervision], you might not need it,” says Robertson. “The response is usually pretty good.”