Ankle Injury

Icing no help to acute sports injuries, especially ankle sprains: take the ice out of “RICE”

by Timothy F. Kirn, Pediatric News, April, 2004

Los CABOS, MEXICO — The ice is out of RICE in the acute treatment of sports injuries, particularly ankle sprains, Dr. James G. Garrick said at a pediatric conference sponsored by Symposia Medicus.

Immediate compression of the injury–the “C” in the RICE acronym (Rest, Ice, Compression, and Elevation), which is a mnemonic for the treatment of an acute sprain-­ is now thought to contribute the most to rapid healing, said Dr. Garrick, who is a team physician for the San Francisco Giants of Major League Baseball.

Icing an injury probably does little to help it heal; studies have shown that subcutaneous fat is such a good insulator that little temperature change can occur beneath it when cold is applied to the skin.

Moreover, icing can cause frostbite.

“We have told athletes to use ice because we don’t want them to use heat,” said Dr. Garrick, who is director of the center for sports medicine at St. Francis Memorial Hospital, San Francisco. ‘”But the evidence for icing an injury is shaky.

“Elevation is fine, and rest is nice,” he added.

Speaking specifically of lateral ankle sprains, Dr. Garrick said that immediate focal compression is the key to proper compression.

When wrapping an ankle sprain initially, the care provider should put a felt horseshoe beneath and surrounding the malleolus, and hold it in place with an elastic wrap. A doughnut shape–or even a sock folded into a U shape–can also be used. The aim is to fill in the hollows surrounding the malleolus, thus providing the focal compression .

The wrap should be left on for about 36 hours.

Compression is meant to prevent further swelling, because swelling leads to loss of motion, which results in muscle atrophy and ankle weakness, Dr. Garrick explained. When focal compression is immediately applied to the injury, individuals with even severe sprains can recover and be able to run in as few as 5 days.

“It will make an unbelievable difference,” said Dr. Garrick, “the big mistake is to delay treatment waiting to see a clinician”.