High Ankle Sprain Comparison: Diligent application of Rest, Ice, Compression and Elevation (RICE) in the first 72 hours vs not so diligent application

In this article I’m going to make the case for really diligently following the principles of Rest, Ice, Compression and Elevation (RICE) in the first 24-72 hours after any sports injury.

 Rest, ice, compression and elevation are all interventions for the purpose of damage control. They slow blood flow into the injured area, which allows the body to more efficiently clot damaged blood vessels, limiting swelling and bruising. This is important, because swelling causes pain and limited range of motion, and the more you have, the longer it takes for the body to cycle it out.

All that to say, diligently applying rest, ice, compression and elevation within the first 24-72 hours after any sports injury will limit pain and swelling that’s allowed to build up, which decreases healing time because the body will spend less time getting rid of all that fluid outside of the circulatory system. Having less pain and swelling also helps speed things up, because the athlete can return to regular everyday function more quickly, and is able to more fully engage in a productive rehabilitation process. And the mindset benefits? Anytime an athlete feels and sees progression, it affects their attitude enormously – and that helps speed up the healing process too.

I have a high ankle sprain with two soccer players as a case in point. They sustained about the same severity of injury. Here are an immediate post injury photo and a photo from 3 days later for each of them.

High ankle sprain 1 - immediately post injury

Diligent application of RICE:

Stayed off of it, wore a compression bandage with a felt horseshoe, iced on schedule as much as possible and elevated his ankle when sitting or laying down as much as possible

• Minimized swelling

• Swelling stayed out of the lower part of the foot

• Swelling was minimized in the joint space due to wearing a felt horseshoe

• Regained normal range of motion much quicker

• Regained normal walking motion much quicker

• Was able to move through rehabilitation exercises more quickly

• Returned to partial practice with tape within two weeks

• Returned to full practice and game play with tape within three weeks

High ankle sprain 1 - 3 days post injury after diligent application of RICE

High ankle sprain 2 - immediately post injury

Not so diligent application of RICE

Stayed off of it, started out with a compression bandage and a felt horseshoe for the first night, left the wrap somewhere and went without it for the next few days, iced sometimes, and elevated his ankle when sitting or laying down

• Large amount of swelling

• Swelling spread throughout the foot and lower leg, as well as pooled in the joint space

• Heightened pain sensitivity of skin due to pressure from swelling 

• Delayed movement through rehabilitation exercises

• Took much longer to regain normal range of motion

• Took much longer to regain normal walking motion

•  Was able to play minimal minutes with tape in the post season after 4 weeks

High ankle sprain - 3 days post injury after not so diligent application of RICE

The key here was wearing the compression wrap

The athlete who was diligent about wearing the compression wrap and the felt horseshoe was able to minimize the swelling that occurred. While he had some, of course, we really didn’t have to take the time to work on getting it out of the lower foot and there wasn’t so much pooled in the joint space where it is more difficult to move swelling out of. The athlete was able to move through rehabilitation exercises quickly and move back into practice after only a few weeks. He wore ankle tape for the rest of the season and continued to do exercises regularly, but had no set backs or problems with re-injury.

The athlete who was not so diligent about wearing his compression wrap, having left it somewhere for a few days over the weekend, had a lot of swelling build up in the lower part of his foot, lower leg and in the joint space. It really limited his ability to regain range of motion, walk normally and move through rehabilitation exercises, so he was much more dysfunctional in regular life than the other athlete, as well as much slower to return to play.