What has RICE got to do with ankles?
Ankle sprains are extremely common, accounting for approximately 25% of all sports-related injuries. For years, the acronym RICE (Rest, Ice, Compression, Elevation) has ruled supreme as the key to early management and has been pushed at sports clubs, school nurses’ rooms, and by doctors Australia wide.
Ok, so why not RICE?
RICE is based on the belief that swelling is bad and must be limited as much as possible.
It is now known that swelling is an essential part of healing and is responsible for clearing away damaged tissue and laying down healthy tissue. In the past 10 years, the justification for icing an injury has melted under scientific scrutiny and it is now believed that ice can prolong recovery and delay return to sport. This is also true of anti-inflammatory drugs which have been shown to impair the early healing phase following injury. Finally, excessive rest has been shown to compromise the strength and quality of the tissue that your body creates.
If not RICE, then what?
Let PEACE guide you after an ankle sprain.
P = Protect
- Unload or restrict movement for 1-3 days. This reduces bleeding and prevents stretching of the injured fibres.
- Depending on the level of injury, you may require crutches. You may also require ankle tape to additionally protect the injury.
- Minimise rest – prolonged rest compromises the strength and quality of the healing tissue.
- Let pain guide how much or little you use the ankle. Mild pain is ok.
E = Elevate
- Elevate the injured ankle higher than the heart to promote fluid flow out of the injured ankle encouraging better circulation to the injured region.
- There is poor evidence for elevation, however, the risk is negligible so it is still recommended.
A = Avoid anti-inflammatory modalities
- Avoid Ice. Whilst Ice has been shown to help with pain relief, it has also been shown to delay tissue healing and result in weaker tissue formation. For this reason, it is advised not to Ice. To better control the pain, reduce activity on the ankle and increase the protection.
- Avoid anti-inflammatory medications. Optimal soft tissue regeneration is supported by the various phases of the inflammatory process. Making use of medication to inhibit the inflammatory process will, in turn, impair the healing process.
C = Compress
- Bleeding and tissue haemorrhage may be limited by light compression provided by Tubigrip or taping methods where required.
- It is important to know that the goal is not to completely prevent the flow of blood to a region as this will prevent the body’s ability to heal itself.
E = Educate
It is our responsibility as physiotherapists to educate you on your condition. This includes but is not limited to:
- Diagnosis and explanation of the injury
- Rehabilitation plan
- Load management (how much your ankle can tolerate and when)
- Expectations of when to return to sport
- Provide you with a referral should imaging be required (Ultrasound, X-Ray, MRI)
- How to prevent a recurrence
- Goal setting
Note: It is important to know that PEACE is used exclusively for the acute phase of healing which lasts less than a week in most cases. During this early phase, it is important to have a Physio assess you to determine the extent of your injury and give you a plan for rehabilitation.
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