How to treat a sprained ankle

The advice until now has been to follow the RICE protocol to treat a sprain, but research suggests you should call the POLICE in. James Witts explains…

Man applying an ice pack to his injured ankle.

Historically, if you’ve sprained an ankle you should have turned to RICE, aka Rest, Ice, Compression, Elevation. But a 2012 study in the British Journal of Medicine proposed it was time to call in the police.


P is for protect so strap the injury, while O and L stand for optimal loading. They’re the major changes.

With RICE you were advised to rest but if you can keep a certain amount of movement, albeit staying within comfortable pain limits, it’s been proven to increase recovery time.

How to reduce swelling

As for Ice, Compression and Elevation, they’re all designed to reduce swelling, which is a big problem for acute problems like ankle sprains. But why? You’d think swelling is the body’s instant method of relief so let Mother Nature play out?

Well, it’s true that it’s part of the healing process and the benefit is that swelling contains chemicals for healing. But the downside is that swelling reduces activity around the joint, so it leads to muscle weakness and instability.

It also tends to make the joint painful and stiff. So if you can reduce that, you’ll probably get movement and feeling back much quicker.

So time to call the POLICE in? Definitely but there is debate over whether you should apply ice or simply compress and elevate. That’s down to work by researcher and sports therapist Peter Thain.

Thain argues that while ice reduces local analgesia (pain relief), there is currently no research involving humans that suggests it reduces swelling.

Studies have examined the effect of ice application on metabolism (which is what the ice needs to suppress) in animal studies and identified the target tissue temperature to be between 5 and 10°C.

This temperature reduction needs to be achieved at depth rather than on the surface and no study has proved that ice reduces temperature at 2cm below the adipose tissue.

Apply wet ice

Thain also suggests that wet-ice use is the ideal where ice is applied through a fabric bag. “This porous material provides a barrier to stop potential ice burn, while the residual water is in contact with the skin,” Thain writes on his blog.

“As wet ice exhibits greater thermal condition than its dry-ice counterpart, that’s the ideal.” However, if it’s a significant trauma, add ice to plastic bag and compress with tape.

“You should the follow this template,” adds Thain. “Apply ice for 10mins on, and then remove for 10mins. In the rest period, reapply the compression bandage. After the 10mins rest, reapply the ice application.

“Continue this cycle of 10 on, 10 off, 10 on for as long as possible. Once finished icing and before you return home, place the compression wrap back on the area.”


Top image: Getty Images