From the Guidelines
For a sprained ankle, I strongly recommend against using the RICE protocol and instead advise functional support, such as the use of a brace, and early exercise therapy to recover joint functionality, as these approaches have been shown to be more effective in promoting recovery and preventing future sprains. The evidence from the British Journal of Sports Medicine 1 suggests that RICE is not advised as a treatment modality after a lateral ankle sprain (LAS), and that functional support and exercise therapy are preferred.
Key Recommendations
- Functional support, such as the use of a brace, is preferred over immobilisation 1, as it allows for early mobilisation and promotes faster recovery.
- Exercise therapy should be started as soon as possible 1 to recover joint functionality and prevent future sprains.
- NSAIDs may be used to reduce pain and swelling 1, but should be used judiciously and under medical supervision.
- Surgery is only advised for patients who require quick recovery, such as professional athletes, or whose complaints are not resolved by conservative treatment 1.
Additional Considerations
- It is essential to identify and address modifiable risk factors, such as predisposing factors, to prevent future sprains 1.
- Prognostic factors should be assessed during the rehabilitation process to address negative modifiable factors 1.
- A communication checklist should be used to ensure effective interprofessional communication and prevent errors 1.
- Supervised exercises with a focus on proprioception, strength, coordination, and function are recommended for sport resumption 1.
From the Research
Evaluation Recommendations for a Sprained Ankle
- A detailed examination focusing on physical examination techniques is important to diagnose ankle sprains and rule out other injuries that may mimic ankle sprains 2
- The hands-on grading of ankle sprains dictates treatment and forecasts recovery time 2
- Most ankle sprains can be successfully treated nonsurgically with PRICE (protection, rest, ice, compression, and elevation) 2, 3
- For patients with chronic pain or instability from an ankle sprain, a directed approach will help physicians fine-tune nonsurgical treatments or suggest a surgical referral 2
- There is insufficient evidence from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults 4
- 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 4
- Use of a standardized protocol enhances the management of ankle sprains, with emphasis on accurate diagnosis, early use of RICE, maintenance of range of motion, and use of an ankle support for patients with grades I or II sprains 3
- Sprains with complete ligament tears (grade III) may require surgical intervention 3