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(Tactically Outdated Ankle Sprain Treatment)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 CaringMedical.com 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.