Should I Still Use RICE To Manage My Ankle Injury?

by Jai Sappal

A bit about RICE and injury

The RICE (Rest, Ice, Compression, Elevation) acronym has been in play for a while now regarding how we manage injuries. You’ve probably seen a player slap an ice pack on their ankle to bring down the swelling after spraining it during a game.

RICE has been used as a form of treatment for decades. It was originally developed in 1978. A doctor hypothesised that this protocol would minimise swelling and assist in recovery. However, in 2017 the person who developed it recanted his original hypothesis (2).

When an injury occurs, there will be inflammation to the injury site. As an example, let us use the previously mentioned ankle injury. All injuries follow a spectrum of a 3-phase process (3):  

  • The first stage is the inflammatory stage. It is characterised by the increase in the amount of blood and repair factors to the area (swelling) which is used to prevent further damage to the ankle. This is also why the ankle looks so puffed up and becomes a bit stiff.
  • The second stage is characterised by new blood vessels reforming around the area (as the old ones were damaged during the injury)
  • The third stage is the remodelling phase. This is where the wound will be healing over and attempts to regain the same strength the tissue had before the injury occurred.


What does the updated evidence say about RICE?

The use of Ice for an injury has been somewhat debunked. It can actually cause an opposite effect to what you might hope for it to do. Using ice is also not supported by evidence in assisting muscle recovery (5). After using ice to assist in recovery for 15 minutes, a study found that icing actually delayed recovery from exercise-induced muscle damage (4). Another review had even found that ice actually damaged the muscle tissue in the attempt to get better (2). What ice can help with is alleviating pain (2).

Using a compression bandage or elevation does not have supportive evidence either (2). Current evidence for compression states its benefits is more based off someone telling you that you should compress the injury and again they are likely quoting the RICE protocol. In reality, the evidence is lacking (6). The same idea applies to the Rest component of RICE and is more in practice due to gaining popularity over decades with no strong supportive evidence (6,7). 


What should I do then if I roll my ankle?

MEAT (Movement, Exercise, Analgesia, Treatment) has been proposed as an alternative to RICE for recovery from injury. It should be a more active approach to treatment. Early range of motion exercises that force more load into the muscles promotes bone and muscle healing (8). A review also stated that exercise in combination with other support (like mobilisations or a brace) should be used to treat ankle sprains, and not just the (P)RICE protocol (P=protect). Furthermore, treatment options like acupuncture, electrotherapy or ultrasound are not recommended by this guideline (9). 

At Peak Health, we like to take that more active approach. Using a collaborative approach with you, the patient, we aim to first get you symptom free by using manual therapy techniques such as massage and mobilisations, and then giving exercises to target range of motion and strength. Each of these modalities are individually tailored to you and how your body is responding. Not every ankle is the same and we treat it as such!

Sources:

  1. https://www1.racgp.org.au/newsgp/clinical/is-it-time-to-rethink-rice-for-soft-tissue-injurie
  2. https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
  3. https://www.ncbi.nlm.nih.gov/books/NBK470443/
  4. https://pubmed.ncbi.nlm.nih.gov/22820210/
  5. https://pubmed.ncbi.nlm.nih.gov/23873339/
  6. https://www.researchgate.net/publication/345037588_The_RICE_Protocol_is_a_MYTH_A_Review_and_Recommendations_thesportjournalorgarticlethe-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/
  8. https://pubmed.ncbi.nlm.nih.gov/10504356/
  9. https://www.ncbi.nlm.nih.gov/books/NBK563007/


Jai Sappal
Physiotherapist
Peak Health Services.