Should sprained ankles be iced?

Traditional method of applying ice should be avoided as it will cut the blood supply to the injured area

Should sprained ankles be iced?

When suffering from a sprained ankle, the old wisdom called for rest and ice to heal a sprained ankle. Gabe Mirkin, M.D., author of  “The Sports Medicine Book," where the RICE(rest, ice, compression, elevation) acronym first appeared back in 1978, used to advocate icing right after a sprain or strain because cooling an injury delays swelling and reduces pain.

Recent debate about the topic, after 2013 review of studies the National Athletic Trainers' Association pointed out that the evidence for icing a sprain is "sparse."Mirkin himself changed his mind saying that icing the injured tissue would cut the blood supply. He told Consumer Reports on Health that he now believes “ice doesn’t increase healing rather it delays it.” Mirkin now recommends skipping ice altogether, unless the pain you're experiencing is unbearable.

Though the controversy, there is enough supporters to back the notion that  ice should be applied on the sprained area. The American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society both back the traditional approach.

“I’m actually a big ice proponent,” said Dr. James Gladstone, co-chief of the Division of Sports Medicine and associate professor of orthopaedic surgery at Mount Sinai School of Medicine in New York City. “I don’t think there’s a new wave necessarily in terms of treatment, and particularly for sports medicine doctors treating athletes acutely.”

Ice nullifies the pain and reduces swelling by constricting the blood vessels, Gladstone explained. “You still get a sufficient inflammatory response even with the ice to get the healing started,” he says. And if icing can reduce swelling enough, it may make it possible to mobilize the joint earlier.

Apply ice packs only two or three times total, for 15 to 20 minutes at a time, with at least an hour in between. If the pain from the sprained ankle is so severe that you can't walk more than three steps, or if the joint is bent in an odd angle, see a doctor right away.

A better option for reducing sprained ankle pain and improving short-term function is taking over-the-counter nonsteroidal anti-inflammatory medications such as ibuprofen (Advil, Motrin IB, and generic) or naproxen (Aleve and generic), according to the recent NATA review.

But take those NSAIDs only for the first 24 to 48 hours, because they, too, slow down recovery by suppressing inflammation. After that, use acetaminophen (Tylenol and generic), which has no anti-inflammatory effects.

The recommendations from our experts still call for compression and elevation parts of the RICE formula. 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 could develop long-term problems, such as osteoarthritis.

Keep in mind that once you sprain your ankle, you’re more vulnerable to spraining it again. That’s because the ligaments lose some of their elasticity. Physical therapy to improve your balance and strengthen the tendons and muscles in your leg and foot can help reduce your risk of more sprains down the road, he said.

You can also minimize swelling throughout the day by elevating the limb. Overnight, if you can, prop a sprained ankle on something such as a pillow.