This week, Medscape published an article that questioned if the current method of ankle sprain care – RICE (Rest, Ice, Compression and Elevation) – was the optimal course of care for most patients. In lieu of RICE, the authors suggest that physicians switch to an acronym known as POLICE, which keeps the ICE, but replaces Rest with Protection/Optimal Loading.
Dr. Eric Robertson, a physical therapist who was interviewed for the article, said many doctors suggest that a patient should “rest” for too long after an injury, and he added, “This RICE construct doesn’t necessarily reflect modern science.”
RICE has been the go-to strategy for years, and it is even cited as a preferential treatment by the American Academy or Orthopaedic Surgeons (AAOS) and the American College of Sports Medicine (ACSM). Could those huge organizations really be wrong?
Both Right
The biggest problem with trying to determine a “one size fits all” guide is that no two ankle sprains are exactly alike. While RICE and POLICE are merely supposed to be viewed as general recommendations, the thought of eliminating rest (or at least severely limiting it) removes the simplicity of the initial management.
As the authors write, “Rest should be of limited duration and restricted to immediately after trauma. Longer periods of unloading are harmful and produce adverse changes to tissue biomechanics and morphology.”
The problem with using a term like “immediate” in the medical sense is that it means different things based on the severity of your ankle condition. Minor, mild, and major ankle sprains will all have different durations of immediate rest. During the first 1-2 weeks after a mild or severe ankle sprain, rest is the most appropriate, and when movement is necessary, protect the area with optimal loading. After that, no one should be doing RICE anymore. Instead, they should begin what we in our office call, AFFR or Ankle & Foot Functional Rehabilitation.
AFFR includes: Protection with an ankle brace, optimal loading in physical therapy where they address the inflammation and swelling, working to improve motion, working to improve strength and then building towards return of full function with balance training, proprioception and functional activities.
Essentially, we’re both saying the same thing. Rest alone isn’t the answer. Proper weight bearing and strength training is key to returning to regular function.
Related source: Medscape
