Jun 2, 2009 4 min read

Question: I sprained my ankle recently. I went to the ER, where they did an X-ray to rule out a fracture. Then they put me in an air splint and told me to go home and “rice it.” It was a mild sprain, and I was off my crutches in a few days, but my ankle was stiff for a while after. I wasn’t really sure what “rice it” meant, and I would like to know if what I did was OK. Answer: RICE is actually an acronym that stands for “rest, ice, compression and elevation,” the standard initial treatment for a mild sprain. Sprains are stretched or torn ligaments, fibrous bands of tissue that connect bones to bones and keep them in place. When you twist your ankle – usually by rolling your foot out so that the sole of the foot turns up – you can injure the ligaments that connect bones in the ankle joint. This scenario, called a lateral ankle sprain, is the most common sprain. The signs of a sprain are pain (general and especially with weight-bearing), swelling and bruising. Sprains can range from mild, like yours, to very severe, which rarely can require surgery or a cast.

As you know, when treating a mild ankle sprain, many practitioners recommend RICE.

– Rest: During the first two days, keep painful activities to a minimum.

– Ice: Ice the injury in 20-minute sessions every three to four hours to reduce inflammation. Anti-inflammatory medications such as ibuprofen also can help reduce pain and inflammation. Take it easy after icing or taking pain-relief medication to avoid re-injury.

– Compression: Your air splint provided some compression, but it also help to wrap an injury with a bandage, especially during elevation. Loosen the bandage if your toes turn cold or blue or begin to tingle.

– Elevation: Lift your injury above your heart whenever you can. At night, prop it up on a pillow.

One variation on this treatment is RICE-M, which adds movement. Movement therapy involves slow, isolated foot motion and should start within the first 72 hours of an injury. I recommend that you sit down, lift the injured leg and slowly circle your foot in both directions a few times. Next, “write” your full name in the air with your toes. Repeat the exercise several times a day. The more you do it, the easier it gets. Also it is important to begin weight bearing. This should be gradual at first, but most people are off crutches in just a few days.

At this point, you should focus on building ankle strength to prevent subsequent sprains. This is especially important during the first few weeks after the injury. Some physicians recommend physical therapy after a bad sprain. There are some easy home exercises you can do, such as picking up marbles with your toes, walking on the balls of your toes, and walking on your heels. Balance activities, such as standing on one foot, can help, since most non-sports ankle injuries occur when people lose their balance on uneven ground.

Simpson is an associate professor of Family Medicine at Ohio University College of Osteopathic Medicine To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or e-mail to readerquestions@familymedicinenews.org.

Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.