From the Guidelines
The RICE method, with a focus on rest and cold application, remains a recommended first-line treatment for acute strains and sprains, as it can help reduce pain and swelling, although its overall efficacy in improving function or time to recovery is still debated. When considering the management of acute strains and sprains, it's crucial to prioritize methods that reduce morbidity, mortality, and improve quality of life. The most recent and highest quality study, 1, suggests that rest and limiting the use of the injured extremity are mainstays of treatment, as they help avoid worsening the injury. Cold application, a key component of the RICE method, can acutely decrease pain and swelling in joint sprains and muscle strains, as evidenced by an RCT of 74 patients with sports-related soft tissue injury 1.
Key Components of Treatment
- Rest: Limiting the use of the injured extremity to prevent further damage.
- Cold Application: Using a bag filled with ice and water surrounded by a damp cloth for 20 to 30 minutes, 3 to 4 times daily, to reduce pain and swelling.
- Compression and Elevation: While their individual effects are less clear, they are often recommended as part of a comprehensive approach to reduce swelling.
Additional Considerations
- Protection: Some clinicians recommend a modified approach like PRICE or POLICE, which adds protection to the injury and gradual introduction of controlled movement.
- Pain Management: Over-the-counter pain medications like ibuprofen or acetaminophen can help manage pain and inflammation.
- Rehabilitation: After the acute phase, gentle movement and rehabilitation exercises are crucial for promoting healing and preventing stiffness.
Severe Injuries
Severe strains or sprains with significant pain, inability to bear weight, or visible deformity require prompt medical evaluation, as they may need immobilization, physical therapy, or in rare cases, surgical intervention. The evidence from 1 and 1 supports a cautious approach, emphasizing the importance of rest, cold application, and potentially, the other components of the RICE method, in the management of acute strains and sprains, with a focus on minimizing morbidity and improving quality of life.
From the Research
Comparison of the RICE Method with Other Treatments
- The RICE method, which stands for rest, ice, compression, and elevation, is a commonly used treatment for acute strains and sprains, including ankle sprains 2.
- However, there is insufficient evidence from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults 2.
- A study published in the Journal of Athletic Training in 2012 found that only 11 trials involving 868 patients met the inclusion criteria, and the main reason for exclusion was the lack of a well-defined control group without the intervention of interest 2.
- The study suggests that treatment decisions for acute ankle sprains 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 2.
- Other treatments for acute strains and sprains may include physical therapy, bracing, and pain management, but the effectiveness of these treatments compared to the RICE method is not well established 2.
- Further research is needed to determine the most effective treatment for acute strains and sprains, including ankle sprains, and to provide evidence-based management strategies for these common injuries 2.