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Rest Ice Compression Elevation (RICE)

RICE is a conservative treatment method that has not been rigorously investigated, and the efficacy of this combination is questionable. The individual elements of ice and compression have been the subject of numerous scientific investigations; however, there is little scientific support for their efficacy in reducing injury-associated symptoms following acute  lateral ankle sprains (LAS).

The limited available evidence showed that the efficacy of cryotherapy for reducing acute LAS injury-associated symptoms is unclear (33 randomised controlled trials (RCTs), n=2337) (level 1). There are no indications that the isolated use of ice can increase function, as well as decrease swelling and pain at rest among individuals who have sustained an acute LAS (27 RCTs, n=1670) (level 2). In combination with exercise therapy, cryotherapy has a greater effect on reducing swelling compared with heat application (one RCT, n=30) (level 2). The combination of cryotherapy and exercise additionally results in significant improvements in ankle function in the short term, allowing patients to increase loading during weight bearing compared with standard functional treatment (one RCT, n=101) (level 3).

Evidence regarding the efficacy of compression therapy after acute LAS is also inconclusive (three RCTs, N=86) (level 2).

As a combined therapeutic modality, the use of RICE plus multimodal physiotherapy compared with RICE alone provides no additional benefits. Both treatments provide pain reduction, increase patient function and reduce ankle swelling (one RCT, n=28) (level 2).

Regarding the individual effects of rest and elevation after LAS, no evidence was available.

What’s new: No new statements could be made based on the newly identified studies. The increased evidence indicates that the individual aspects of RICE are not effective, apart from cryotherapy, if provided in combination with exercise therapy.

Recommendation (modified): There is no evidence that RICE alone, or cryotherapy, or compression therapy alone has any positive influence on pain, swelling or patient function. Therefore, there is no role for RICE alone in the treatment of acute LAS

Fuente: Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline

Sobre Aritz Monasterio

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