Ankle Sprain... RICE versus POLICE!
What we learned in PT school is that ankle sprains are best managed by RICE (Rest, Ice, Compress, and Elevate).
Studies are suggesting that RICE should be replaced by POLICE (Protect, Optimally Load, Ice, Compress, and Elevate). The “Protect” means brace and/or tape.
This RCT involved 100 patients with acute grade 1 or 2 ankle sprain who visited an emergency clinic. The patients were randomized into 2 groups.
Group 1: All patients got the RICE protocol
Group 2: All patients got the POLICE protocol which included immediate weight bearing as tolerated, ankle ROM and strengthening exercises as tolerated by pain
Result: Patients in the POLICE group who did not fully rest had more rapid recovery with respect to function and walking endurance.
Clinical Relevance: Focus should be less on rest and more on activity for patients with grade 1 or 2 ankle sprains.
Clinical Question: How much WB is ideal after a soft-tissue ankle injury? How long should a person rest and limp for?
Q: How much does a dog WB when it has a soft-tissue injury?
A: As much it can based on pain!
Q: How long does a dog limp for after an injury? A: As long as it needs to!
I would go one step further and take Ice out of POLICE and replace the “I” with ????. If you have not yet read my rant on ice, please visit www.aptei.ca and go to Clinical Papers.
References:
Bleakley CM et al Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010 May 10;340:c1964.
Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? Br J Sports Med. 2012 Mar;46(4):220-1.
