Ankle sprain? Is it enough to know the RICE principles? Emergency ankle sprains, which are almost the most common type of orthopedic emergencies, account for about 25% of skeletal muscle injuries, most of which are lateral ligament injuries. The RICE principles are classic for the emergency management of ankle sprains: Rest: stop walking and allow the injured area to rest to reduce further damage; Ice: lower the temperature of the injured area to reduce the inflammatory response and muscle spasm and to relieve pain and inhibit swelling. Apply ice for 10-20 minutes each time, more than 3 times a day, taking care not to apply ice directly to the affected area, but to wrap it in a wet towel to avoid frostbite. Ice should only be applied within 48 hours of injury. Compression: Wrap the injured ankle with an elastic bandage and apply appropriate pressure to reduce swelling. Be careful not to overcompress as this may increase the swelling and ischemia of the limb farther away from the wrap. Elevation: Elevate the limb above the heart position to increase venous and lymphatic return, reduce swelling and promote recovery. Grading of ankle sprains are usually graded into 3 levels depending on the severity of the ankle injury. Grade 1: There is stretching of the ligaments, only microscopic damage to the ligament fibers, and mild pain. Weight bearing is possible as long as it is tolerated; splinting is not required; isometric contraction exercises are possible; full range of joint mobility exercises and muscle strength training can be performed if tolerated. Grade 2: Partial rupture of ligament fibers, moderate pain and swelling, limited mobility, and possible joint instability. Immobilization with splinting or bracing, physical therapy, and muscle strength and joint mobility exercises are required. Grade 3: Complete ligament rupture with significant swelling and pain and joint instability. Braking and rehabilitation are the same as for grade 2, but the rehabilitation time is longer and in a few cases surgery is required. In 2012, the British Journal of Sports Medicine recommended replacing the current RICE principles for the treatment of ankle injuries with POLICE: Protect, Optimal loading, Ice, Compression, Elevation. This principle places a strong emphasis on early activity. It has been suggested that for grade 1 and 2 ankle sprains, joint mobility exercises and gradual weight bearing after a few days can lead to a faster recovery. In grade 3 ankle sprains (complete ligament tears), there is evidence to support early braking within 10 days of injury, after which ankle motion is initiated. Of course, many authors still support 2-3 weeks of braking for grade 3 injuries. The general recommendations are Phase 1, 1 week of RICE principles, rest to protect the ankle and reduce swelling; Phase 2, weeks 2-3, gradual return to joint mobility, strength, and flexibility; and Phase 3, over the next few weeks to months, gradual return to sports, starting with sports that do not require twisting of the ankle and eventually returning to sports. Medication The available evidence recommends only nonsteroidal anti-inflammatory drugs to control pain and inflammatory response. It is worth noting that there is no clear evidence to support all topical medications and manipulative rubbing for revision. Surgical Treatment Only a very small number of patients with grade 3 injuries require surgical treatment after months of failed systematic non-surgical treatment. These patients are typically those with severe injuries, significant instability, and high motor demands. Ankle instability usually presents with a positive anterior drawer test and a positive talar tilt test, as well as a positive talar tilt test on orthogonal inversion stress radiographs of the ankle, and MRI is useful in determining ligament tears. The stability of the ankle joint can be better determined by a later examination. The surgical approach can be considered arthroscopic or open reconstruction to repair the ligamentous structures.