Ankle sprain treatment strategy: POLICE or RICE ?
POLICE: Protest, Optimal Loading, Ice, Compression, Elevation
RICE: Rest, Ice, Compression, Elevation
Is the current treatment strategy for ankle sprains wrong?
The clinical notion that RICE principles (rest, ice, compression, elevation) need to be followed after an ankle sprain or strain is well established, but Robertson, a spokesperson for the American Association of Rehabilitation Physicians, recently made the surprising observation that the RICE treatment strategy after an ankle sprain or strain is not A reasonable measure, such patients should begin exercise exercises for the injured joint as early as possible after the injury. The RICE principle is used as the standard treatment strategy after an ankle sprain or strain in the official web pages of orthopaedic authorities such as the AAOS and the American College of Sports Medicine, and in most of the classic textbooks.
Even proponents of the RICE principle and members of the AAOS acknowledge that the RICE principle is only a recommended measure for first aid after an ankle sprain or strain, not a clinical treatment principle. RICE principles.
Ankle sprains can affect thousands of people
Ankle sprains or strains are relatively common in everyday life, and the condition is self-limiting and can heal on its own. The literature reports that the number of ankle injuries occurring in the United States approaches 28,000 per day, but a systematic review published in the American Journal of Medicine found that only 35-85% of patients with ankle injuries healed within 3 years.
Based on these findings, the treatment of ankle injuries has received a lot of attention from clinicians in recent years, and a review published in the British Journal of Sports Medicine in 2012 strongly recommended replacing the current RICE principles for the treatment of ankle injuries with POLICE: protect, optimize loading, ice, compression, and elevate the affected limb. compression, and elevation of the affected limb.
In the review article the authors suggest that rest after ankle injury is limited to the initial phase of the ankle injury and that rest periods should be as short as possible, and that prolonged periods of no weight bearing on the ankle are potentially damaging to the joint and can lead to negative changes in joint tissue biomechanics and morphology.
In 2013 the National Athletic Trainers’ Association (NATA) published the first official guidelines for the management of ankle sprains, and researchers combined the last 6 years of literature to classify ankle treatment options from best to worst evidence level as A, B, and C. Most of the RICE principles for management are rated C, but unfortunately most physicians in the clinic are still following the principles.
Research evidence supports early activity over rest
The NATA researchers found current level A evidence to support rehabilitation functional exercise after ankle injuries grade I (distraction, ligament fiber injury), and grade II (partial ligament tear). There is no direct evidence for immediate weight-bearing walking after ankle sprains, but some randomized controlled studies have found that joint mobility exercises and increased weight-bearing for several days after ankle sprains can lead to faster recovery from ankle sprains, and massage therapy by an experienced physical therapist can help patients regain function of the ankle as soon as possible.
For grade III ankle sprains (complete ligament tears), there is level B evidence to support early braking within 10 days of injury and initiation of ankle motion thereafter. However, the authors also emphasize that a more conservative treatment strategy is more appropriate for patients with ankle tibiofibular joint injuries or more severe ankle sprains.
Balance exercise and NSAIDS medication are the current evidence level A treatment measures. NSAIDS medications are controversial in the treatment of ankle sprains, and Kaminski et al. recommended against the use of NSAIDS medications within 48 hours of injury, so they may have an impact on the prognosis of the joint by inhibiting the inflammatory response early in the injury.
However, since there is no strict evidence against the “restrest” strategy in the RICE principles, the braking strategy cannot be excluded from the ankle treatment principles in clinical practice.
Rethinking the RICE principles
Kaminski believes that ice, compression, and elevation of the affected limb still have a role in the treatment of ankle sprains, but that ice may not be as effective as one might think. Compression and elevation of the affected limb may theoretically reduce edema in the affected limb by reducing tissue fluid exudation and lower limb perfusion. Swelling of the affected limb may delay tissue healing.
Although there is no strong evidence to support that the above treatment measures fundamentally improve the clinical functional prognosis of ankle sprains, Stephen, president from the ACSM, also supports the idea that reducing edema can improve healing of the patient’s extremity.
AAOS spokesperson Barbara believes that patients can benefit from the application of the RICE principles and that the current clinical evidence does not completely negate their usefulness in the management of ankle sprains, but she also emphasizes that the RICE principles are not medical management guidelines, but only recommended first aid measures for non-medical personnel following ankle sprains or strains. In some non-emergency situations, non-medical personnel can use the RICE principles to manage a sprained ankle on their own.
However, both proponents and opponents of the RICE principle agree that each disease is individual and that the treatment of ankle sprains should, in principle, be individualized. Robertson et al. emphasized that the RICE principle is not inherently dangerous, but that there may be better options for treating ankle sprains than the RICE principle.