If you’ve ever sprained an ankle or knee, you’ve probably heard that rest, ice, compression, and elevation—RICE—for a couple of days is the surest route to recovery. But some experts, including the same doctor who coined the term RICE, now question the “rest” and “ice” parts of the formula.
Forget the Ice
Gabe Mirkin, M.D., author of “The Sports Medicine Book," where the RICE acronym first appeared back in 1978, used to advocate icing right after a sprain or strain because cooling an injury delays swelling and reduces pain.
But he changed his recommendation after reviewing the latest research. For example, a study published in 2014 by the European Society of Sports Traumatology, Knee Surgery & Arthroscopy found that putting ice on injured tissue shuts off the blood supply that brings in healing cells. “Ice doesn’t increase healing—it delays it,” Mirkin says,
And a 2013 review of studies on the best ways to treat a sprained ankle, conducted by the National Athletic Trainers’ Association, agrees. It gave icing a grade of "C."
Mirkin now recommends skipping ice altogether, unless the pain you're experiencing is unbearable. If that’s the case, apply ice packs only two or three times total, for 15 to 20 minutes at a time, with at least an hour in between. If the pain from the sprained ankle is so severe that you can't walk more than three steps, or if the joint is bent in an odd angle, see a doctor right away.
A better option for reducing sprained ankle pain and improving short-term function is taking over-the-counter nonsteroidal anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, and generic) or naproxen (Aleve and generic), according to the recent NATA review.
But take those NSAIDs only for the first 24 to 48 hours, because they, too, slow down recovery by suppressing inflammation. After that, use acetaminophen (Tylenol and generic), which has no anti-inflammatory effects.
Forget Complete Rest
The old wisdom also called for completely stopping activity until an injury healed. New research suggests that gentle exercise within the first 48 to 72 hours, such as “drawing” the alphabet with a sprained ankle two to three times daily, is more beneficial.
The 2013 NATA review gave top marks to such early movement. “By contracting and relaxing a joint, you improve blood flow, which improves healing,” says A. Lynn Millar, Ph.D., author of the American College of Sports Medicine’s patient guide to sprains and strains.
The NATA study also found that balance exercises are important for reducing the rate of reinjury—a frequent complication of sprains. Download a PDF of these exercises from acsm.org, or ask your doctor for therapy suggestions.
Some Advice Stays the Same
The recommendations from our experts still call for compression and elevation parts of the RICE formula. So go ahead and wrap a mild strain or sprain of your arm or leg with an elastic bandage to help reduce swelling. But once swelling subsides, unwrap. Otherwise, research shows, the injured joint could develop long-term problems, such as osteoarthritis.
You can also minimize swelling throughout the day by elevating the limb. Overnight, if you can, prop a sprained ankle on something such as a pillow.
Editor's Note: This article also appeared in the December 2015 issue of Consumer Reports on Health.
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