FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

"RICE" KEY TO TREATING ANKLE SPRAINS

Question: While playing tennis last week, I hurt my ankle. My doctor said that I only have a sprain. In fact, I've sprained my ankle before. I know what a sprained ankle looks like and how it feels, but I don't really understand what causes it. Would you explain a sprained ankle for me, please?

Answer: A sprain any sprain is the stretching and/or tearing of ligaments that support a joint. You see, the bones that meet to form a joint are held together by tough fibrous ligaments. These limit the amount of normal bending movement that a joint can have as well as provide stability so the joint doesn't "wobble."

To explain this further, I need to describe the difference between ligaments and tendons. Many people confuse these two body structures because both of them are often injured in the same mishap. A tendon is an active, moving piece of fibrous tissue that connects the end of a muscle to bone. The power of a muscle contraction is carried by the tendon across the joint to pull on the bone resulting in joint and limb movement. The ligaments at this joint guide and limit the amount of movement. They are only passive supporting structures.

Ankle sprain is the term we use to describe a condition where some or all the ligaments in the ankle become torn. They become injured as the ankle is "folded in" or turned inward. Often the individual hears a pop and experiences a tearing sensation. There is usually immediate pain that is promptly followed by swelling. I know you are familiar with all of these symptoms.

In a mild sprain only a few of the fibers of the ligaments are torn, and the pain may be bearable and walking still possible. For this type of sprain, and in fact for all sprains, proper initial treatment is described by the acronym "RICE." This stands for Rest, Ice, Compression, and Elevation. In other words, Rest means promptly getting off the injured foot. Ice should be used to reduce the swelling, but don't keep the ice bag on the injury for more that 20 minutes out of each hour. Compression is achieved by simply wrapping the injured ankle with an elastic bandage. And Elevation requires lying down and keeping the ankle several inches above the level of the heart. Four or five pillows placed under the foot will do the trick. Failing to elevate the ankle high enough can lead to increased accumulation of fluid in the tissues. This increased swelling will cause more pain and can delay healing.

More serious sprains require a doctor's attention, but do RICE as you travel to the doctor's office or the hospital emergency department. In more serious injuries, when your ankle hurts so badly that you can't walk, you have probably injured more than a few strands of the important supporting ligaments. In these situations your doctor will immobilize your ankle with a splint, bandage or cast to hold the ankle bones in proper position while the ligaments heal. He or she may also prescribe pain medication. In the most serious cases, where all of the supporting ligaments are torn, surgery is necessary to repair the damage.

After one to two days of RICE, it is time to begin a rehabilitative program. It is usually possible to place some or all your weight on the ankle if it is protected with a special support brace. Therapeutic exercises are needed to encourage good range of motion as well as adequate leg muscle strength. Your doctor may teach you these exercises, or you may be referred to a physical therapist for this phase of treatment.

I commonly see individuals with repeated episodes of sprained ankles just as you have had. This is often a consequence of failing to take the rehabilitative part of treatment seriously. This is unfortunate because a "once sprained" which becomes a "frequently sprained" one can sustain permanent damage.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.