Sprains and Strains

Rice Therapy

RICE stands for the most important elements of treatment for many injuries-Rest, Ice, Compression and Elevation.

 Stop using the injured part as soon as you realize that the injury has taken place.  Use crutches or a cane, if recommended, to avoid bearing weight on the injured foot or ankle. 

 Ice helps stop bleeding from the injured blood vessels and capillaries.  Sudden cold causes the small blood vessels to contract.  This contraction decreases the amount of blood that can collect around the wound.  The more blood that collects, the longer the healing time.  Ice can be applied in many ways:
 - For injuries to small areas, such as the toe or foot, immerse the injured area in a bucket of ice water for 15-35 minutes.  Use ice cubes to keep the water cold, adding more as the ice melts. 
 - For injuries to larger areas, use ice packs.  Avoid placing ice directly on the skin.  Before applying the ice, place a towel, cloth or two layers of elasticized compression bandage on the skin to be iced.  To make the ice pack, put ice chips or cubes in a plastic bag or thin towel.  The pack may sit directly in the injured part or be wrapped in place. 
 - Ice the injured area for about 30 minutes. 
 - Remove the ice and allow skin to warm for 15 minutes. 
 - Reapply the ice
 - Repeat the icing and warming for 3 hours.  Follow the instructions below for compression and elevation.  If pain and swelling persist for after 3 hours call our office.  You may need to change the icing schedule after the first 3 hours.  Regular ice treatment is often discontinued at 24-48 hours.  At this point heat is sometimes more comfortable. 

 Compression decreases swelling by slowing bleeding and limiting the accumulation of blood and plasma to the injured area.  Without compression fluid from adjacent normal tissue seeps into the injured area.  To apply compression safely to the injury:
 - Use and elasticized bandage (ace bandage) for compression if possible.  If you do not have one available any kind of cloth will suffice for a short time.  
 - Wrap the injured part firmly.  Wrapping over ice, begin wrapping below the injured site and extending above the area.
 - Be careful not to compress so tightly that the blood flow to the area is impaired.  Signs of deprivation of blood supply include pain, numbness, cramping, and blue or dusky nails.  Remove compression immediately if any of these symptoms appear.  Leave the bandage off until all signs of impaired circulation disappear.  Then rewrap the area less tightly this time.  

 Elevating the injured part above the heart is another way to decrease the swelling and pain at the site.  Elevate the iced, compressed area in whatever way is most comfortable.  Prop the injured foot or ankle on a solid object or pillows. 

Most ankle sprains and strains are inversion injuries in which the foot twists inward, damaging the lateral ligaments on the outside of the foot. 

Pronation injuries to the medial ligaments on the inside of the, caused by twisting the foot outward, are less common.

 Sprains are graded on a scale of 1 to 3 (mild, moderate and severe), reflecting the amount of tearing of the ligaments.

In evaluating these injuries, the physician usually orders x-rays to rule out a fracture or dislocation.

 Treatment usually involves the RICE approach- Rest, Ice, Compression, Elevation.  Rest means keeping off the injured ankle as much as possible.  Crutches may be used to aid in this.  They allow the patient to move about when necessary with out placing weight on the injured ankle as much as possible.  An Air Cast, splint or cam boot may be applied to the ankle for additional support.  Severe sprains occasionally require a hard cast.  Icing the injury reduces the swelling.  Ice packs are usually applied for 20 minutes at a time, every hour as long as swelling persists.  Compression means supporting the ankle and foot with a firmly (not tightly) wrapped elastic bandage, compression stocking or gel wrap.  If swelling causes the bandage to become too tight, it should be loosened immediately.  Elevating the the foot above heart level minimizes bruising and swelling.  This should be done as often as possible during the first 48 hours.  

The physician may also prescribe a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, to reduce pain, swelling and inflammation.  Some patients experience prolonged swelling caused by the formation of excessive scar tissue.  

The physician may request x-rays to recheck for small, previously undetected bone fragments or damage to the joint.  

With proper treatment most ankle sprains and strains heal within 2 to 6 weeks.  Severe injuries may take as long as 12 weeks.  

A carefully monitored program of physical therapy may be required to restore full muscle balance and strength.  This can involve stretching the Achille's tendon as well as coordination and speed exercises.  During this time taping and bracing the ankle may be prescribed to provide support until full function is regained.  

Patients who have experienced an ankle injury are at risk for an another during the recovery period and thereafter.  An injured ankle, even though healed, may be unstable and prone to recurrent injury.  For this reason, patients who have sustained an ankle injury should take precautions.  

Shoes that provide stability and support are a prudent investment.  Supplemental bracing with a specially fitted elastic wrap may be recommended.