Written by Makayla Phea and edited by Josephine Chan
Have you ever felt pain shooting through your leg after stepping in an unseen divot? You have likely experienced a sprained ankle. Athletes encounter this feeling at a higher incidence, with ankle sprains accounting for 16-21% of all sports related injuries [1]. As the most common lower limb injury in athletes, sprained ankles are frequent in sports involving jumping, cutting, or twisting actions [2]. Although common, there is currently no existing treatment that immediately treats and heals ankles sprains, so it is imperative to evaluate the effectiveness of current practices to identify areas of focus and craft a tailored treatment plan for athletes with ankle sprains.
As an athlete makes a move to change directions, the force at which they plant their foot puts them at risk of forcing their ankle beyond its normal range of motion. When this happens, the ankle ligaments, or fibrous pieces of tissue that connect bones, are stretched and sometimes torn, resulting in one of two types of sprain. An inversion sprain is most common; it results from the foot rolling outwards, causing damage to the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments, two bands of tissue that run along the outside of the ankle [3]. An eversion sprain is less common and occurs when the foot turns inwards and the deltoid ligament along the inside of the ankle is stretched [3].
When these injuries occur, the first line of treatment that athletes and coaches often refer to is the rest, ice, compress, and elevation (RICE) method, which became protocol for sprains upon the publication of Dr. Gabe Mirkin’s 1978 “Sports Medicine Book” [4]. The principles of this method aim to relieve pain and swelling during initial injury and potentially aid in recovery and mobility [5]. However, in a book published in 2013, medical exercise program development specialist Gary Reinl challenged the effectiveness of the RICE method, stating that the technique delays the recovery process while potentially causing further damage to affected tissues [4]. In a trial studying the effectiveness of cryotherapy on ankle sprain treatment for 33 randomized control subjects, there was no significant improvement to ankle pain, function, or swelling after using ice [6]. More so, 11 studies of 868 patients, aiming to examine the RICE method in treatment of ankle sprains, did not find evidence to support the effectiveness of RICE therapy, even if immobilization early in the recovery process was beneficial [7]. Even the initial proponent of the RICE method, Dr. Mirkin, retracted his support of the method after research examining the validity of the RICE protocol was published [4].
With this information, what should athletes do to treat sprained ankles? Functional treatment is one possibility, as it aims to improve ankle mobility and prevent joint stiffness and loss of motion. However, this method is limited at early stages of rehabilitation, as short term follow-ups did not provide much functional insight on its effects [8]. Athletes should not lose hope, though, as acupuncture, electroacupuncture, and pharmacopuncture with bee venom, while not clinically recommended, are methods needing further research on their effects [9]. Furthermore, since pharmacopuncture has anti-inflammatory and pain relieving effects, further investigation into the benefits forms of acupuncture could prove to be effective at additional treatments to ankle sprains.
References
1. Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012). Diagnosis and treatment of acute ankle injuries: Development of an evidence-based algorithm. Orthopedic Review, 4(1). https://doi.org/10.4081/or.2012.e5
2. Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World Journal of Orthopedics, 11(12), 534–558. https://doi.org/10.5312/wjo.v11.i12.534
3. Sprained ankle – orthoinfo – Aaos. OrthoInfo. (n.d.). https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/#:~:text=Around%2090%25%20of%20ankle%20sprains,the%20outside%20of%20the%20ankle
4. Scialoia, D., & Swartzendruber, A. J. (2020, October 30). The R.I.C.E protocol is a myth: A review and recommendations. The Sport Journal. https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
5. Rice (rest, ice, compression, and elevation). UK HealthCare. (n.d.). https://ukhealthcare.uky.edu/orthopaedic-surgery-sports-medicine/treatment/rice
6. Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle Sprains: Evaluation, Rehabilitation, and Prevention. Current Sports Medicine Reports, 18(6), 217–223. https://doi.org/10.1249/JSR.0000000000000603
7. Ortega-Avila, A. B., Cervera-Garvi, P., Marchena-Rodriguez, A., Chicharro-Luna, E., Nester, C. J., Starbuck, C., & Gijon-Nogueron, G. (2020). Conservative Treatment for Acute Ankle Sprain: A Systematic Review. Journal of Clinical Medicine, 9(10), 3128. https://doi.org/10.3390/jcm9103128
8. Van Der Wees, P. J., Lenssen, A. F., Hendriks, E. J. M., Stomp, D. J., Dekker, J., & De Bie, R. A. (2006). Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: A systematic review. Australian Journal of Physiotherapy, 52(1), 27–37. https://doi.org/10.1016/S0004-9514(06)70059-9
9. Ruiz-Sánchez, F. J., Ruiz-Muñoz, M., Martín-Martín, J., Coheña-Jimenez, M., Perez-Belloso, A. J., Pilar Romero-Galisteo, R., & Gónzalez-Sánchez, M. (2022). Management and treatment of ankle sprain according to clinical practice guidelines: A PRISMA systematic review. Medicine, 101(42), e31087. https://doi.org/10.1097/MD.0000000000031087