Ankle injuries are extremely common all over the world and happen anywhere, anytime. The severity differs vastly and as a result, ankle injury treatments are also numerous. Based on professional advice, treatment can be done at home (in the community), or in hospital.
In this article, we will deal with mild ankle injuries which can be managed at home. These injuries of the soft tissues around the ankle, are called sprains. And the treatment of ankle sprain to be discussed here has the acronym, “RICE Treatment”.
In the next paragraph, we shall give essential information on which ankles to treat at home. The following paragraphs will then tackle each arm of RICE (Rest Ice, Compression, Elevation).
HOW TO SELECT CANDIDATES FOR RICE TREATMENT
It is important to be aware of patients / injured people who cannot be managed at home. These are the instances where there should be a high index of suspicion for a severe injury:
- if the patient cannot walk or weight-bear on the affected limb. This is highly suspicious of a fracture. X-ray examination is necessary. Treatment can only be undertaken in hospital or other suitable health facility.
- children under the age of 18. In this situation, even if the injury does not appear to be severe, the suspicion should be a fracture. Children do not sprain ligaments. Rather, the delicate part of their bones called the GROWTH PLATE is what gives in. X-ray examination is necessary, including comparison with the other limb.
- if the limb is too lax and / or painless after the sprain. This suggests a complete ligament tear. Though this is a soft tissue injury, its severity warrants surgical treatment (repair) in hospital.
When treating ankle sprains, it is essential to rest the limb for 4 -5 days. Ideally dear Reader, this must be COMPLETE rest. A Sick Leave should be sought from the work or study place.
Rest enables and accelerates healing. It prevents repeat injury, or extension of existing damage. Rest also makes pain management easier.
I – ICE
This is one arm of treatment that should be instituted immediately after injury occurs, for best results. Ice blocks, wrapped in cloth or bandage, should be applied to the injured part.
If ice is not available, the coldest water available should be used.
This cold treatment helps to combat inflammation. It reduces swelling of the injured soft tissues, and collection of inflammatory fluid (effusion). This greatly reduces pain and discomfort (and helps healing).
The cold packs should be continued twice daily. This should be done for as long as necessary, but certainly at least for the duration of the above rest. (The ice or water should be applied before the below dressing under C.)
A common mistake all over the world, is to use warm or hot water! While this may feel soothing at times, it attracts blood flow and inflammatory processes. This causes or worsens swelling and ultimately, pain too!
(I personally advise clients to use “I” to remind them of Inflammation reducing medications, or anti-Inflammatories. These can be used as an adjunct, for pain and inflammation that do not settle with the Ice packs. But preferably, start with simple, safe paracetamol.
If paracetamol doesn’t do the trick, you can then escalate to the Non-Steroidal Anti-inflammatory Drugs, NSAIDs. These usually overcome swelling and pain more effectively.)
C – COMPRESSION
The C can also be used to remember Crepe bandage.
A dressing, usually in the form of a bandage, should be applied around the ankle joint. This should be done by a skilled person, who:
- knows how to apply the dressing under sufficient pressure
- will be able to apply the dressing in a manner that brings the damaged soft tissues together. This is important for the optimal healing of the soft tissues
Compression also squeezes out fluid / effusions, and prevents reaccumulation.
Another function of a compressive dressing, is to inhibit the proliferation of (pus-forming or bacterial) infections. This function is summed up in a Spanish saying. The saying translates to “infection is destroyed in the fire of compression”.
E – ELEVATION
This last but not least arm of ICE treatment, is probably the least adhered to. Perhaps people find it demanding to practice diligently. But it really is important and arrangements should be made to enable it.
Elevation involves the requirement that the injured part of the limb (ankle in this case) should be elevated at all material times. This elevation should be practiced day and night (the foot or lower leg can be placed on a pillow or two at night). Elevation should only be broken briefly e.g. when going to the toilet.
The ankle should be placed at a level that is higher than the thigh or waist. This facilitates fluid to gravitate towards the thigh, all the way back to the heart. Thus, elevation prevents swelling (and pain).
Sprained ankle treatment can be done effectively and safely in the community. But it is essential to be sure that the ankle injury sustained, is indeed a sprain. Any suggestion of a more severe occurrence such as a bone crack or joint dislocation, should lead to immediate consultation of a health professional.
Prompt institution of the RICE sprained ankle injury treatment yields much more success. And the four arms of the treatment have to be adhered to strictly. Unfortunately such adherence is often wanting, which leads to slow and / or incomplete recovery. Subsequently, unfair doubt may be cast on this very effective and validated treatment approach.
RICE treatment of ankle sprains is reliable, easy to follow and easy to memorise.
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