The RICE treatment for ankle sprains

Ankle sprains are extremely common and top the charts for A&E attendance when it comes to musculoskeletal injuries. These injuries tend to become immediately painful and the treatment is focused on reducing pain and stimulating healing. 


The commonly used RICE principles are a natural way of reducing symptoms based on Rest, Icing, Compression and Elevation. Others have added a P to the acronym to come up with PRICE. P stands for Protection, but I find this is already covered under the R for Rest: Take the pressure off your ankle, avoid standing or walking for long periods of time and instead sit or lie down. If weight bearing is too painful, try using crutches or a stick for support.


Next, Icing may help in the first few days after the injury. There are commercially available ice packs or a frozen bag of peas or corn wrapped around your ankle will do the same effect. It is better to apply ice for short periods of time and repeatedly during the day. Little and often is better than not regularly and try to space your ice applications throughout the day.


Compression involves wrapping the ankle up with an elastic bandage or a made for purpose ankle brace. Ensure that your compression is snug but avoid applying too much pressure. If it feels uncomfortable loosen it up as it might compromise circulation.


Elevation is by far the most important step in the initial treatment of ankle sprains. In my opinion this also applies to post-surgery situations or in cases of fractures. It will help to reduce swelling and therefore alleviate pain. Those patients that come to clinic with a severely swollen and painful ankle are those that have generally been on their feet for too long.


RICE is a good protocol that helps dealing with the symptoms of an ankle sprain. Having said that, recent guidelines of the British Journal of Sports Medicine, challenged the positive effect of this therapy. They found no evidence that RICE or its individual components (rest, ice, compression) have any positive influence on pain, swelling or patient function. It is possible that the combination of RICE and physiotherapy or pain medication could foster the effects than those of just RICE alone. In any case, and given the safe profile of RICE, which is basically a natural therapy, I would err on the side of action and include RICE in the management of sprains because even in the least favorable of cases it will do no harm but it is likely to contribute to the overall comfort during the painful initial stages of a sprain.