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To Ice or Not to Ice a Sprained Ankle

Posted on December 14, 2021

Rest, ice, compression, and elevation or RICE, as it is commonly known, has been the standard of treatment for injuries since the acronym was coined by Dr. Gabe Mirkin in 1978 in “Sportsmedicine Book.” Since that time, RICE has been considered the standard in caring for injuries.  You would be hard-pressed to find someone who sprains their ankle and doesn’t immediately stick an ice pack on it.

However, in recent years the RICE approach, particularly the icing component, has been challenged throughout medical literature, even with Dr. Mirkin himself publishing an article on how ice may, delay recovery.

While icing after an injury is generally used to reduce inflammation, swelling and pain, inflammation is a normal component of the healing process.  It is not uncommon for inflammation to last for several hours to many weeks following a serious injury. Therefore, clinicians are concerned that using ice to block the normalphysiological process during this time may result in delayed healing. Icing acts as a vasoconstrictor, meaning the blood vessels to the area reduce in size, thereby reducing blood flow. Blood flow to an injured area helps to facilitate the healing. Additionally, there have been studies that have shown the vasoconstriction from icing remains for extended periods of time, meaning that this lack of blood flow occurs for longer than just the time that the ice is applied. Furthermore, cryotherapy has been shown to delay the growth of new blood vessels.  Like vasoconstriction, this results in decreased blood flow and delay of healing properties to the injured site, which is important the weeks and months following an injury.

There is also conflicting evidence as to the effects of icing on swelling, as well as reducing pain. Some of the literature seems to promote modest benefits, while others do not. A newer study, published in May 2021, investigated whether icing had any effect on pain intensity, swelling, or range of motion after acute ankle sprains. The overall take-away was that there was no improvement on swelling, pain, or range of motion when compared with exercise alone.

Are the other parts of RICE still important for a Sprained Ankle?

Rest:  Although protecting the injury is important, early weight-bearing and movement of the ankle joint can be beneficial and complete rest is sometimes not advised.  There are exceptions and you should always check with your doctor, however, many people with lateral ankle sprains can bear weight as they are able to tolerate. Moving and gradually using the area can help maintain a better range of motion.

Compression: If there is a lot of swelling, use a compression sock or ace bandage to provide compression. It should be tight, but not so tight that it cuts off circulation or is painful. This will help minimize some of the swelling that makes the ankle feel stiff.

Elevation: When resting, it is still a good idea to elevate the ankle above heart level to help reduce swelling in the area. The rest of the day gravity is pushing swelling down into the foot and ankle.

If you have injured your ankle, it’s always best to have it checked out by the doctor and make sure that it is not fractured. Panorama Orthopedics & Spine Center offers walk-in care – no appointment needed – at both the Highlands Ranch and Golden locations.