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ankle care


for everybody

pt. 3

R.I.C.E. is T.O.A.S.T.

(Tactically Outdated Ankle Sprain Treatment)

“RICE”, Rest-Ice-Compression-Elevation, is a general soft tissue injury treatment protocol that became most closely associated with ankle injuries. Because “ice” is embodied in RICE, it became the therapy’s focus. "We’ve told athletes to use ice because we don't want them to use heat," is a description offered by sports medicine pioneer James G. Garrick, MD. Ice is nice to have, but it’s not needed for acute ankle care.

Ross Hauser, MD on wrote:

"For many athletes a doctor’s recommendation of the RICE protocol for healing their sports related soft tissue issue injury was seen as the gold standard of care. However, this treatment is now under criticism from a surprising source, the doctor who created the RICE treatment guidelines, Gabe Mirkin, MD.

In a recent article on his own website, Dr. Mirkin admits that both ice and rest (key components of RICE) may delay healing. This insight comes nearly 40 years after Dr. Mirkin authored the The Sportsmedicine Book (1978), where he coined the acronym RICE"

The tactical problem with R.I.C.E. is lack of detail. R.I.C.E. assumes swelling occurred and range of motion is lost.  Preserving range of motion is key to a rapid recovery and why preventing swelling is paramount. R.I.C.E. has no tactical sense of urgency against swelling. The myth of ice is that it will prevent swelling, which it won’t. Ice has a positive impact in reducing pain and does contribute to reducing swelling, but not preventing it. Compression is by far the most important tool in the treatment plan. R.I.C.E. ignores the importance of compression and that it’s not general compression that you need. 


As Garrick attests, “Early use of a proper focal compression wrap is the most important measure in managing swelling”. A standard in sports medicine for decades, a DIY-Care kit now let’s an average person use focal compression as primary first-aid for an ankle injury.

Focal Compression - What is it and how does it work?


If our ankles were cylindrical, without high and low areas, an elastic wrap by itself would work well to manage swelling. However, applying just a wrap to an injured ankle forces swelling into the hollow areas around the ankle knobs, robbing the joint’s range of motion(ROM), which is exactly what you don’t want. A Focal Compression wrap’s donut pad fills these hollow areas so that equal pressure from the wrap gets applied to all areas. This keeps swelling out of these low areas and preserves ROM, so rehab exercises can begin. It’s easier, faster and more cost effective to retain ROM than to have to regain it. Immediate use of focal compression is comparable to a tourniquet for bleeding. It is highly effective. If you’ve wondered how a big time athlete can be back in action in days when it takes the “average Joe” weeks, focal compression is likely the reason.

What Top Sports Docs & The American College of Sports Medicine Say:


"It's critical to get on top of the injury quickly. Swelling delays recovery, so, logically, the more you prevent, the better off you'll be. Proper focal compression, applied immediately to the injury, or even if it's the next day, is the paramount measure for a rapid recovery. Regardless of severity, initial treatment of ankle injuries is the same. A pre-treatment diagnosis is not needed. Proper initial treatment allows an early return to activity even for those with severe sprains. Focal compression makes an unbelievable difference, the big mistake is to delay treatment waiting to see a clinician." James G. Garrick, MD, Sports Medicine Pioneer

ACSMs Primary Care Sports Medicine book cover quoted on focal compression to reduce recovery time

"Focal compression effectively manages the cascade of physiologic events, post injury, with prompt intervention to mitigate swelling that leads to pain, decreased range of motion (ROM), joint laxity, and needless delays. Action to minimize swelling greatly reduces recovery time." ACSM's Primary Care Sports Medicine, Chapter 35

"The FirStep Kit lets the best-practice of focal compression be applied where and when it's needed most. When tasked with keeping folks on the job or field of play, FirStep makes a huge difference." Eric McCarty, MD, Chief of Sports Medicine and Head Team Physician for all University of Colorado Athletic Teams

Buying Back Time

Focal compression is an important tool for those needing a speedy return to activity and those charged with their care. Champions of this method will tell you “it cuts recovery time in half.” Being able to prevent or quickly resolve swelling has made it a “best practice” of the enlightened. “Buying back time” can be a reality with the FirStep™ Fast Ankle Care Kit.  KEEP ONE WITH YOU!

Keep reading Part 4 to understand the best practices for overnight care after an ankle injury.

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