If you’ve ever sprained an ankle or knee, you’ve probably heard that a couple of days of rest, ice, compression and elevation — RICE — is the surest route to recovery.
But some, including the doctor who coined the term RICE, now question the “rest” and “ice” parts of the formula.
Before attempting any treatment, determine whether you need to call your doctor. “If you can’t walk more than three steps, you need to see a doctor as soon as possible to protect yourself from further injury,” says A. Lynn Millar, author of the American College of Sports Medicine’s patient guide to sprains and strains. The same holds true if you are in a lot of pain, if the joint looks abnormal (such as bent in a strange way) or if you have significant swelling. But for injuries that cause only minor swelling and pain — and that allow almost a full range of motion — Consumer Reports’ experts suggest the following:
The old wisdom called for completely stopping activity until an injury healed. New research suggests that gentle exercise within the first 48 to 72 hours, such as “drawing” the alphabet with a sprained ankle two to three times daily, is more beneficial.
In 2013, a review of studies on therapies for ankle sprains — which are by far the most common minor injury — by the National Athletic Trainers’ Association gave top marks to such early movement. “By contracting and relaxing a joint, you improve blood flow, which improves healing,” Millar explains.
The NATA study also found that balance exercises are important for reducing the rate of re-injury, a frequent complication of sprains. To find exercises, ask your doctor or go to acsm.org and type “sprains” in the search box.
Gabe Mirkin, author of “The Sports Medicine Book,” where the RICE acronym first appeared in 1978, used to advocate icing right after a sprain or strain because cooling an injury delays swelling and reduces pain.
But he changed his recommendation after reviewing the latest research. For example, a study published in 2014 by the European Society of Sports Traumatology, Knee Surgery & Arthroscopy found that icing injured tissue shuts off the blood supply that brings in healing cells. “Ice doesn’t increase healing — it delays it,” Mirkin says, and the NATA study backs him up: It gave icing a grade of C.
Mirkin now recommends skipping ice altogether, unless pain is unbearable. (If that’s the case, apply ice packs only two or three times total, for 15 to 20 minutes at a time, with at least an hour in between.)
A better option for reducing pain and improving short-term function, according to the NATA review, is an over-the-counter nonsteroidal anti-inflammatory medication such as ibuprofen (Advil, Motrin IB and generic) or naproxen (Aleve and generic). But use these drugs only for the first 24 to 48 hours, because they, too, slow down recovery by suppressing inflammation. Instead, use acetaminophen (Tylenol and generic), which has no anti-inflammatory effects.
The recommendations from Consumer Reports’ experts still call for compression and elevation. So go ahead and wrap a mild strain or sprain of your arm or leg with an elastic bandage to help reduce swelling. But once swelling subsides, unwrap. Otherwise, research shows, the injured joint may develop long-term problems such as osteoarthritis. You can also minimize swelling by elevating the limb throughout the day and overnight — by propping a sprained ankle on a pillow, for instance.
For further guidance, go to ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.