R.I.C.E. is T.O.A.S.T. – Tactically Outdated Ankle Sprain Treatment

sprained ankle

Decades ago the acronym “RICE”, short for Rest-Ice-Compression-Elevation, evolved into a soft tissue injury treatment protocol. Although general in theory, it became most closely associated with ankle injuries. Because ice is embodied in RICE, it became the focus of this therapy. “We’ve told athletes to use ice because we don’t want them to use heat,” is the description offered by sports medicine pioneer James G. Garrick, MD, Founding Director of the Center for Sports Medicine at Saint Francis Memorial Hospital in San Francisco and a team physician for MLB’s San Francisco Giants. Ice is a nice to have item, not a need to have item for early ankle care. “Use of a focal compression wrap is, without question, the most important measure.” It is a standard in sports medicine.

[su_note note_color=”#d8d8d8″]

Sports Injures RICE: Why We Do Not Recommend It”, Ross Hauser, MD
The RICE protocol for treating soft tissue injuries was seen as the gold standard of care. RICE is now under criticism from a surprising source, the doctor who created the RICE treatment guidelines, Gabe Mirkin, MD. In an article on his own website, Dr. Mirkin admits that ice and rest (key components of RICE) may delay healing. This insight comes 36 years after he authored the “Sportsmedicine Book” (1978), where he coined the acronym, but as Mirkin states, “it now appears that both ice and complete rest may delay healing, instead of helping.”[/su_note]

Focal Compression – What is it and how does it work?

If our ankles were cylindrical, without high and low areas, an elastic wrap by itself would work to manage swelling. However, applying just a wrap to an injured ankle forces swelling into the hollow areas around the ankle knobs, robbing the joint’s range of motion(ROM), which is exactly what you don’t want. A Focal Compression wrap uses felt or foam pads, in horseshoe and donut shapes, to fill these hollow areas so that equal pressure from the wrap is applied to all areas. This keeps swelling out of these low areas and preserves ROM, so rehab exercises can begin. It’s easier, faster and more cost effective to retain ROM than it is to have to regain it. Immediate field use of focal compression to prevent swelling is comparable to a tourniquet for bleeding. It is highly effective.

Ankle Sprain Treatment Method

Adopting a New Standard

Excerpts from Top Sports Docs & The American College of Sports Medicine 

References to the use of a “focal compression wrap” as the best method to prevent or eliminate swelling are numerous. Google “Focal Compression for Ankle Injury” (About 176,000 results).

[su_note note_color=”#d8d8d8″]It’s critical to get on top of the injury quickly. Swelling delays recovery more than any other factor. Logically, the more swelling you prevent, the better off the patient will be. Proper focal compression, applied immediately to the injury, or even if it’s the next day, is the paramount measure for a rapid recovery. Regardless of severity, initial treatment of ankle injuries is the same. A pre-treatment diagnosis is not needed. 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.
James G. Garrick, MD, Sports Medicine Pioneer[/su_note]

[su_note note_color=”#d8d8d8″]It effectively manages the cascade of physiologic events, post injury, with prompt intervention to mitigate swelling that leads to pain, decreased range of motion (ROM), joint laxity, and needless delays. Aggressive action to minimize swelling greatly reduces recovery time.  ACSM’s Primary Care Sports Medicine, Chapter 35[/su_note]

[su_note note_color=”#d8d8d8″]“The FirStep self-care kit allows the best-practice of focal compression to be self-applied where and when it’s needed the most. When tasked with keeping folks on the job or field of play, it makes a huge difference.”  Eric McCarty, MD – Chief of Sports Medicine and Head Team Physician for all University of Colorado Athletic Teams[/su_note]

Buying Back Time

Focal compression is an important tool for both those needing a speedy return to activity and those charged with their care. Champions of this method will tell you “it cuts recovery time in half.” The ability to prevent swelling with immediate use, or to resolve it quickly after its occurrence has made it a standard protocol with the enlightened. It’s as if you could “buy back time” with this treatment method and the FirStep™ Fast Ankle Care Kit.