Return to play after an ankle sprain

Last night, I watched our u18 girls play. Late in the first half, a player twisted her ankle and left the game. With her eyes tearing, she went to the end of the bench where her best friend attempted to help her by taking off her shoe, and the assistant women’s coach immediately got an ice pack for her. 

The coach tossed the ice pack to me, as I was walking to check on her. I held the pack. I asked if she could put pressure on her foot. She said yes. I told her to get up and walk on it. I tossed the ice back to the coach.

She limped and walked for a couple minutes, and she calmed down. As I wrote previously, pain is a construct of the brain. The initial pain often is due to the shock and the brain’s signal of danger than to the severity of the injury. She told me that she felt okay, and I agreed, and said the pain was more due to the initial shock. She agreed.

I asked her coach if she wanted her to return to the game. The coach decided not to play her again because she had a senior women’s game today that was more important. We moved to the next stage of treatment with the goal being to prepare her to play the next day.

I wrapped her ankle with a Voodoo band (see video below), and she sat on the end of the bench and elevated her foot for 10-15 minutes. Again, two other people tried to give her ice, and I managed to intercept both.

After the 10-15 minutes, she spent the rest of the game walking behind the bench. I checked on her in the 4th quarter, and she was able to jump and hop without a noticeable difference between legs. She played in the senior women’s game that started roughly 15 hours after her original injury.

Why did I prevent the player from using ice? Everyone knows that RICE (rest, ice, compression, elevation) is the accepted treatment for an injury like an ankle sprain. Whereas it is accepted, is it the best treatment? When a player twisted his ankle earlier in the season, and went to the doctor, the doctor told him to rest 3-5 days and ice the ankle. Who am I to suggest that a medical doctor was incorrect? Of course, he missed almost two weeks of practice time and games doing his own form of rehab (he went home, so I never saw him), whereas this player could have returned to the same game and played the next day without any rest or ice (just compression and elevation).

The two videos below explain some of the processes involved with healing an injury like an ankle sprain, and explain reasons that icing a sprain may be inappropriate.

How to Heal a Sprained Ankle – Rest and ice do… by scottdom

As mentioned by Scott Malin in the first video, several studies have questioned the use of ice to heal an ankle sprain. Bleakley et al. (2010) found that a group performing early therapeutic exercises compared to a group receiving the standard protection, rest, ice, compression, and elevation intervention improved ankle function and was more active in the first week after the grade 1 or 2 sprain. A systematic review of 11 trials with 868 patients by van den Bekerom (2012) in the Journal of Athletic Training found “Insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults.”

I am not a medical doctor, and I am not offering medical advice. However, based on my experience, and a sampling of the research, there is little evidence to suggest that rest and ice help in the healing of an ankle sprain.

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