Do you know any cutting edge data on treating a sprained ankle?
January 26, 2014 12:17 PM   Subscribe

I know "PRICE" Protect, Rest, Ice, Elevate, are there any other things that can help immediately after a sprained ankle, or in the days/weeks after? Are there any scientific studies or journal articles you can link me that show any different or other treatments? I'd like to do anything I can to help healing (foods, human growth hormone, drugs, needles, therapies, anything). By the way,I know I can Ice for 20 minutes, every hour (the most aggressive recommendation I've heard), but if I can take it, can I ice for longer, more often? Coincidentally I have been doing endurance Ice bath immersion lately, so I know I can withstand much longer in an ice bath (70 minutes in 5 degree Celsius water) so wouldn't that be better than 20 minutes every hour?
posted by crawltopslow to Health & Fitness (8 answers total) 2 users marked this as a favorite
The C stands for Compression, I'm not sure whether that's a typo or you have assumed its the C in Ice.
posted by biffa at 12:33 PM on January 26, 2014 [1 favorite]

Response by poster: oh yeah, I left Compression out on accident, yes I know it's compression. Thanks.
posted by crawltopslow at 12:38 PM on January 26, 2014

The ice (and elevation and compression) is to bring down the swelling, which causes tissue damage. Icing for 20 minutes every hour is already very aggressive, as you say. More than that won't really help and you're risking doing tissue damage instead of preventing it, if you're not careful with how you're applying the ice. 20 minutes of direct (and sometimes indirect) contact with ice can give you a nasty burn. For a dramatic example, this guy needed surgery and skin grafts to repair the tissue damage from over-aggressive icing.

I don't know anything about endurance ice baths, but if you already know you're safe with them for 70 minutes, that seems like a good complement to icing, but you'd be risking hypothermia if you stay in it for hours and hours.

You'll get the best results if you rest it as much as possible now to avoid further injury, ice a moderate amount (and follow the rest of PRICE), and invest in physiotherapy/rehab once you get past the acute injury phase i.e. no longer swollen and extremely painful. Time and rest are by far the biggest factors.
posted by randomnity at 1:39 PM on January 26, 2014 [1 favorite]

Active Isolated Stretching, developed by Aaron Mattes.

This is Aaron working on a sprained ankle. Technical, but truth.

Points: "active' refers to actively firing the antagonistic muscles from those that are being stretched. These are short (< 2 second) stretches. Generally very low pressure externally, about a pound. Most related to range-of-motion exercises, and I'm not kidding about gentle and short.
posted by dragonsi55 at 3:11 PM on January 26, 2014

Icing for extended periods of time is counter-productive.

Cold* decreases swelling because your body's initial reaction to cold is vasoconstriction, which shunts fluid away from the affected area. However, after 10-15 minutes** of sustained cold, your body compensates for a percieved threat of local cold damage by vasodilating and sending excess fluid to the area, which will actually make the healing process slower and less effective. This is why it's neccessary to take breaks and allow your tissues to return to normal temperature. A similar, but opposite, reaction exists for heat application.

*I can't remember what cold was defined as in my hydrotherapy class but I believe it was 5° C to 0° C. Cool, ehich I believe is 10°C to 5° C, can be applied for longer, about 5 minutes of additional time.

** This assumes that the temperature is sustained- a compress or bucket of water will warm up due to your body heat and in theory could be applied longer and simply become ineffective due to the water temperature rather than your body's mechanisms. If there's ice in the bucket, you're unlikely to warm it with your body heat and it could be legitimately dangerous.
posted by windykites at 4:16 PM on January 26, 2014 [2 favorites]

I tell you what you can do to prolong the agony - don't use crutches. Seriously, mom & dad, I love you and all, but 2 days out of school an no crutches was a really BAD idea.
posted by plinth at 4:43 PM on January 26, 2014

Best answer: Best practice that I was taught on cryotherapy is icing for 72 hours after the injury, at most 10-15 minutes an hour, and at most once an hour (to allow the flesh to warm, and prevent the protective inflammatory response from leaving it on too long). Ice doesn't have to be in direct contact with the skin, and doesn't need to be at 0 degrees C - it just needs to be colder than your flesh.

A good general review of evidence here by NCOR.

After the first 72 hours, contrast bathing is recommended instead. Despite the name, this doesn't have to involve immersion in water, just alternating hot and cold.
Apply cold for 30 seconds to a minute, then heat for the same. I usually recommend a cycle of five (CHCHC) but the important thing is to make sure to finish on cooling, otherwise, again, you lead to an increase in inflammation rather than a reduction.

Contrast bathing overview, not entirely positive, also by NCOR.
posted by fizban at 1:43 PM on January 27, 2014

Air splint. Works 100x better than ice, an ACE wrap, or anything like that.
posted by gramcracker at 5:44 PM on January 27, 2014

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