Evidence for ICE after an ankle sprain

NewsBot · Aug 11, 2012

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What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?
van den Bekerom, Michel P.J.; Struijs, Peter A.A.; Blankevoort, Leendert; Welling, Lieke; Van Dijk, C. Niek; Kerkhoffs, Gino M.M.J.
Journal of Athletic Training, Volume 47, Number 4, August 2012 , pp. 435-443(9)

Context: Ankle sprains are common problems in acute medical care. The variation in treatment observed for the acutely injured lateral ankle ligament complex in the first week after the injury suggests a lack of evidence-based management strategies for this problem.

Objective: To analyze the effectiveness of applying rest, ice, compression, and elevation (RICE) therapy begun within 72 hours after trauma for patients in the initial period after ankle sprain.

Study Selection: Eligible studies were published original randomized or quasi-randomized controlled trials concerning at least 1 of the 4 subtreatments of RICE therapy in the treatment of acute ankle sprains in adults.

Data Sources: MEDLINE, Cochrane Clinical Trial Register, CINAHL, and EMBASE. The lists of references of retrieved publications also were checked manually.

Data Extraction: We extracted relevant data on treatment outcome (pain, swelling, ankle mobility or range of motion, return to sports, return to work, complications, and patient satisfaction) and assessed the quality of included studies. If feasible, the results of comparable studies were pooled using fixed- or random-effects models.

Data Synthesis: After deduction of the overlaps among the different databases, evaluation of the abstracts, and contact with some authors, 24 potentially eligible trials remained. The full texts of these articles were retrieved and thoroughly assessed as described. This resulted in the inclusion of 11 trials involving 868 patients. The main reason for exclusion was that the authors did not describe a well-defined control group without the intervention of interest.

Conclusions: Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.
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Mark Russell · Aug 11, 2012

Conclusions: Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults. Treatment decisions must be made on an individual basis, carefully weighing the relative benefits and risks of each option, and must be based on expert opinions and national guidelines.
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Sometime the quality of research is breathtaking! The effectiveness of any Rx is dependent on making the correct diagnosis in the first instance - this is where the problems in managing ankle ligament injuries arise from. I have lost count of the number of times someone comes in for advice after lateral ankle sprain and informs me that they have been to A&E and had been given an x-ray - but "nothing was broken" and they were advised to go home with some ice and a compression bandage. Two weeks later they still can't weightbear and their lower leg is still the colour purple...

If anyone in the NHS orthopaedic community with some influence on national triage policy is reading these posts, please, please include an ultrasound scan during your investigations otherwise all the ice in the Arctic won't make any difference if the ligament has been disrupted.

Admin2 · Aug 11, 2012

Related threads:
Other threads tagged with ankle injury
Risk factors for ankle sprains
Functional ankle instability
Immediate manipulation for ankle sprain
Treatment of the Distal Fibular for Lateral Ankle Sprains
Anterior positional fault of the fibula after ankle sprains
Overuse of x-rays for ankle injury
Neuromuscular stimulation early after ankle sprain

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