To make sure that you know best practice, I will be describing each step of RICER in red, followed by what I was actually able to do with the limited resources and other constraints put on me. Where possible, always follow RICER to a tee, but if you can't try a more creative approach, like mine.
R = REST
Rest your ankle (no exhaustive exercise, minimal walking/standing) for 48-72 hours.
As soon as I rolled my ankle, I stopped running. I tried to stand on the ankle, realized it was very sore, and told my friends to keep running - I had to stop. I then sat down on the side of the track to rest the ankle, while I tried to work out how to ice, compress and elevate my ankle, with no equipment, and with my wallet locked in my friend's car.
If you have to hunt around for some improvised equipment, rest is going to be difficult, but try to work out a plan to do all of your walking at once - this minimizes the actual time you will be standing and walking.
After I manage to get through the first few hours before I got home, resting was easy. I just hung out on the couch until Sunday.
I = ICE
Apply ice to the ankle for 20min, every 2 hours for the first 48-72 hours.
I didn't have an ice-pack. I resolved to take off my shoe and sock, and let it rest in the cold, dewy grass for about 20min, while I waited for my friend with the car keys to come past again. Once I got my wallet, I bought a slushy from 7/11 - the plastic cup was able to mould around the shape of my ankle, and it was cold enough.
Ice packs are the best way to cool your ankle because they hold their temperature for longer, but a large slushy worked long enough for what I needed, so long as I kept stirring it when it warmed-up.
C = COMPRESS
Apply a compression bandage ASAP after the sprain, and leave it on for 48-72 hours
The only thing I had that could get tight enough to compress my ankle was my running shoes. They're too thick to be able to ice and compress the ankle at the same time, so I resolved to ice for 20min, and compress for 20min until I could get better compression gear.
On the way from The Tan to brunch, I stopped in at a chemist and got an ice-pack and strapping tape. I used the strapping tape to compress the ankle, but that's because I had diagnosed he ankle as sprained, and could tape it accordingly. The lay person can get a compression bandage and ask the chemist to apply it for you.
E = ELEVATE
Elevate the ankle above the heart ASAP after the sprain and have it elevated as much as possible for 48-72 hours
I was surprised (and disappointed) to see how low the park benches are at The Tan - too low to elevate an ankle above the heart while sitting, so I had to lie down. I put my jumper on the grass so I didn't get too cold.
At brunch, I elevated the ankle on a chair - that certainly wasn't above my heart, but it is at least higher than it would have been otherwise.
At home, it was easy to elevate the ankle on some pillows while I was lying down, or on the couch while I was sitting on the floor.
R = REFER
Get in touch with a sports health professional ASAP to get a diagnosis and treatment plan.
Over the weekend, I referred to my own expertise, but asked a colleage to double-check my diagnosis and treatment plan on Monday - even for professionals, self-diagnosis can be shonkly. I started needling (see pic above) and some low-impact exercise straight away on Monday
Even if the ankle still hurts - the sooner you get a treatment plan in place (even if the plan involves resting for a few more days), the better results you will get.
The moral of this story is that RICER is important. You might not be able to get it 100% right, but every little bit you can do in the right direction makes a difference.
For more information on first-aid, email me directly via the contact page. For specific information on an injury you have, or for treatment, contact one of my clinics directly. You can find that information here.
I am committed to evidence-based practice, so it is important to say the following regarding my use of acupuncture for my sprained ankle: the research evidence into acupuncture in the treatment of acute ankle sprains in unclear.
A 2014 review into the effectiveness of acupuncture by the U.S. Department of Veteran's Affairs demonstrated a potential positive effect, whereas a subsequent study published in the Cochrane Library has sated that there is insufficient evidence to definitively support or reject the use of acupuncture in these cases.
Speak to your doctor about your specific injury for advice about whether acupuncture is the right treatment method for you.
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Dr Mitch Clark