Friday, August 3, 2018

Ankle Sprains - Forget RICE

I sprained my ankle this week. Everyone I talked to told me to RICE (rest, ice, compress, elevate). Even the doctor. Being lazy af, I decide not to, because icing takes too much effort and compression hurts. Just to be safe, I read about ankle sprains. (And selectively ignored all articles that told me to RICE).

My takeaway: RICE isn't very proven to be effective. Instead, just laze around for the first day or two after injury (forget the ice, elevation, compression busyness). Then as soon as you can, start moving/walking/loading (but 15min a day is enough). Even in the first day or two, start movement if you can. Also, use of NSAIDs is inconclusive.

Some snippets below:
-"Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines."
-"In general it is recommended that injuries should be allowed “to rest” during the inflammatory phase, and that mobilisation should begin at the earliest when the inflammation has subsided and the regenerative phase has started (many probably do not dare to start then either). We have tested this “clinical truth” in our rat model and found, completely unexpectedly, that loading during the first 6 days had an equally favourable effect as loading during the regenerative phase. It is obvious that loading in some way favourably modifies inflammation."
-"We also investigated the length of time required for loading to produce a beneficial effect and concluded that 5 minutes once a day is enough. If the time is extended to 15 minutes then a better effect is obtained but increasing the time any further has little benefit."…/how-do-tendons-and-ligaments…/
-"The Whartons advocated that once fracture or catastrophic injury is excluded: movement is best, not rest, to treat an injury. They encourage immediate but gentle restoration of active range of motion with gradual introduction of functional activities. They note that inactivity shuts the muscle down. Blood flow is restricted and tissue atrophy follows. In contrast, activity improves blood flow, which brings oxygen and removes metabolic waste."