Treatment for Acute Injuries: Remember P.R.I.C.E.

PRICE therapy

 

Here I will use an Ankle Sprain as an example of Acute Injury needing PRICE.

Following an Ankle Sprain, it is important to create a pain free environment. The keys components have been taught in High School and College Health Classes forever.

 

P----Protection

R----Rest

I-----Ice

C----Compression

E----Elevation

 

    Protection is always a start so that the injury does not re-occur in the days, weeks, and months following the acute episode. The rule of thumb is that the second sprain is always worse than the first. Braces, like those worn after an ankle sprain, are needed until the surrounding muscles get strong again. However, a type of shoe, an orthotic, a pad, some tape, a splint, can also be part of the protection to give crucial “protected weight bearing”. Here an orthotic to stabilize the arch is used to protect the injured posterior tibial tendon which supports the arch. With the orthotic device in place, the injured tendon does not have to work as hard and can mend faster.

Orthotic device used to center the heel in a pronated foot.

 

    Rest is a four lettered word to most athletes, but crucial in minimizing the re-aggravation of the ankle. Rest is created by whatever it takes to make the ankle pain free. This may be crutches, removable cast, ankle brace, limited activity, and/or completely getting off the foot involved. I tell the patients that we must use Activity Modification principles, but never use the R word!! The first 4 days after a sprain is the most crucial time to chill out. Yet, since no one can really be sure 100% of the time what is wrong, the first 2 to 3 weeks following a sprain should be relatively pain free.

 

    Ice for 96 hours following a sprain is crucial. Other Anti-Inflammatory Measures are also helpful. Yet, ice is used for months and months in a typical sprain, it is just knowing when to use it that is important. You use it constantly after activity, or for 4 straight days after any flare-up.

 

Compression is also crucial to move swelling out of the swollen area. The product seen below is of Tubigrip, but a common substitute is an Ace Wrap.

The secret to compression is to put more compression below and less compression above the ankle. This may require some tape of some type to hold on the wrap above the ankle. Make sure this tape is not wrapped all the way around and possibly cut off the circulation.

 

Elevation of the foot and ankle even 1 inch off the floor is very beneficial. As long as it is comfortable, and as long as there is swelling, try to elevate the foot and ankle as much as possible. Super Elevation once a day for 30 minutes is very important. Super Elevation is where you lie on the floor and elevate your foot on the wall or couch 3 feet above your heart. Combine this with compression and gentle non painful range of motion of the ankle and the swelling will improve  greatly.

The above is from my book "Secrets to Keep Moving". I hope you will read it to learn how I practice podiatry.

My wife, Patty, and I just got back from a great week in South Lake Tahoe. We had some excitement with an experience with a nearby bear. The sunset was glorious, but the orange/red glow is from the Wildfire nearby! Sad!

Initial Treat of Injuries or Flares: The Immobilization Phase of Rehabilitation

Please enjoy my important video on the thought process behind the initial treatment of injuries, athletic or not, and reflares of older injuries. These general rules discussed by the acronym PRICES are commonly not followed and rehabilitation is delayed or prevented. The initial 4 days of any injury or flare are vital to the healing of that injury. I hope it helps. Rich

https://youtu.be/DJBIhb2kQQg

Ankle Sprain Advice

Hi, Dr. Blake -

It's been almost a year since I last was in contact with you.  I sprained my ankle today, and wanted to check in with you.  Last year it was the right ankle, today it was the left.  I looked at your blog, but I wanted to clarify a few things with you directly.

I am elevating and icing and took some ibuprofen.  I still have a few compression socks and horseshoe padding from last time.  Should I start that right away?  Should I not use the padding while icing?

I remember how to do the contrast baths, but I seem to recall that I'm supposed to wait a day or two before starting those.

I have attached a couple pictures of my ankle.  It swelled up right away.  It also feels somewhat different than last year's injury.  With that one, I was able to walk without limping.  This one causes me to limp.  I was not in motion when my ankle rolled, but I was standing on an elevated surface, and rolled down from that (if that makes sense :)

Please let me know if I should come in to see you.  I'm pretty sure it's just a sprain.

Thanks, 

Roberta

Roberta, 

     Thanks for the email and I am so sorry about the sprain. Until the swelling is gone for 2 straight weeks, you should use compression 24/7. Those compression socks will help you, along with the horseshoe padding. I am going to use your email for my blog tomorrow, but will remove your identity (probably call you Roberta). Ice for 96 hours, then begin the contrasts at 1 min hot, 1 min cold for 20 minutes. When you ice you can remove the compression. Schedule with me for Wednesday on, but cancel if it is getting better and better. I will try to be even more thorough in my blog. Rich

     When you sprain your ankle, you need to immediately control the swelling. The more PRICE you do over the first 4 days, the assault and battery days, and the less swelling you have by the end of those 4 days, the faster your ankle will recover. Now, Roberta's (identity removed) ankle looks more like a high ankle sprain (the ligaments above the ankle called the tib-fib ligaments), and it could be a distal fibular bone fracture. So the next few days will tell us if we should xrays. Ankle sprains get better and better, ankle fractures go much slower. So, if Roberta is not feeling a significant improvement with the ability to weight bear on the 5th day post injury, we should definitely be xraying her. I always recommend weight bearing xrays on the foot and ankle since sometimes how the bones line up to the ground and each other can make a difference in diagnosis and/or treatment. To summarize PRICE for you, it is:

Protection: crutches, bracing, removable boots,etc

Rest: Restricting motion of the ankle just enough to not stimulate the pain response

Ice: All the wonderful Anti-Inflammatory measures we have available including avoiding certain foods.

Compression: Remember Compression should be tighter below the injury and looser above the injury

Elevation: Even 1 inch off the floor makes a difference, but get it up as much as you can for the first 4 to 14 days.Control that swelling.

I will leave a Rx for ankle xrays on my asst Kathy's desk. If you feel you should get an xray, call her, schedule an appt, and go to xray 1 hour before. Rich