You’re doing it wrong-sprains and strains

Traditionally, the acronym RICE which stands for rest, ice, compression, elevation was used to treat sprains and strains. You’d be surprised to learn that actually; the researcher who suggested RICES as the best line of action himself now disagrees with the concept. Even more shocking… it’s the “rest” and “ice” aspects that are outdated.

We often see patients coming into the clinic on crutches or with braces on to immobilise the painful joint. This, however, can cause muscle atrophy and weakness, stiffness and nerve denervation.

Even though studies as far back as 1994 by Eiff, Smith and Smith found that even though immobilisation prevented acute symptoms (Ex. Pain), it provoked long term ankle instability and weakness.

Additionally, the use of ice has not been proven to benefit recovery either. Some research has revealed that it can decrease the sensation of pain, but in terms of treatment, there is inconclusive evidence to support it. For example a systematic review by Bleakley, McDonough and MacAuley (2004) concluded that not enough high quality studies were present to support the use of cryotherapy in acute injury. Although it has been shown to reduce pain, spasm, blood flow, metabolism and inflammation… this isn’t always a good thing! We need the inflammation and the influx of the white blood cells to help progress healing. If we impede these away from the area of injury, the healing rate may decrease.

So why have we still stuck to the “RICE” approach even if research dates back so far found adverse effects with it? In the simplest terms… old habits die hard, and reduction of pain decreases the likelyhood of catastrophisation and therefore hopefully avoiding exercise avoidance.

I suggest next time you want to treat your injury, think about what structures are damaged, how damaged they are and what damage can be done by immobilisation. Additionally, when prescribing modalities, consider why, as some patients will likely use their HEP time to ice and rest, as they will consider it to be equally beneficial as “that’s what the physio told them” rather than actually do the Home Exercise Program due to comfort levels and “lack of time”

 

 

Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury a systematic review of randomized controlled trials. The American journal of sports medicine, 32(1), 251-261.

Eiff, M. P., Smith, A. T., & Smith, G. E. (1994). Early mobilization versus immobilization in the treatment of lateral ankle sprains. The American journal of sports medicine, 22(1), 83-88.

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