Ankle Sprains :
Research Shows They Were Wrong
“It now appears that both ice and complete rest may delay healing, instead of helping.” 1
Gabe Mirkin, MD, Creator of R.I.C.E. (Rest, Ice, Compression, Elevation)
There is a great deal of recent research that strongly supports the healing techniques of H.E.M. Ankle Rehab while also completely demolishing the myth that ice and rest will effectively heal a sprained ankle. Please, see below…
ICE IS NOT EFFECTIVE FOR HEALING AN ANKLE SPRAIN
The National Athletics Trainers Association found that ice was an over-simplified method and NOT effective at speeding up the healing process for a sprained ankle.
“The inflammation process assists in healing. We don’t want to interrupt that”, says Tom Kaminski, the lead on the study.
Therefore, the study also suggests you SKIP compression too, which had no real impact on recovery.
Finally, the study found that exercise helped to maintain blood flow and flexibility to the injured ankle, both of which are proven to speed up recovery. 2
ICE CAN CAUSE PERMANENT NERVE DAMAGE
Researchers found that when muscle tissues cool from icing the skin, blood vessels constrict and shut off the blood flow that brings in healing cells.
After the ice is removed, the blood may then return, but the blood vessels may not open for many hours after the ice application.
This research team found that this can cause the tissue to die due to lack of blood flow. It can also lead to temporary or permanent nerve damage and disability in the individual or athlete.
Therefore, ice application does not boost recovery after exercise and can instead cause tissue and nerve damage. 3
ICE DISRUPTS THE NATURAL HEALING PROCESS
It is essential to understand that inflammation is NOT bad. It is a critical part of the healing process.
Tissue that is damaged through trauma or vigorous exercise requires inflammation. When muscles and other tissues are damaged, your body sends inflammatory cells to the damaged tissue to promote healing.
Inflammatory cells rush to the injured tissue to start the healing process. 4
Powerful immune cells called macrophages release a hormone called insulin-like growth factor (IGF-1) into the damaged tissues after an injury.
IGF-1 is essential for helping damaged muscles and ligaments heal. Gabe Mirkin, MD states, “Applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.”
Healthy, fast healing is significantly aided by INCREASED blood flow. Obviously then, decreased blood flow means slower healing times and increases the chance of re-injury or the development of chronic pain.
Did you ever wonder why almost all athletic trainers and therapists ice a limb for ONLY 20 minutes?
In 1980, at the American Orthopedic Society meeting for Sports Medicine in Big Sky, Montana, and then again in 1981, physicians from the Louisiana State University School of Medicine reported on five athletes who obtained nerve palsies (nerve injuries usually to the peroneal nerve that moves the foot up) from too much ice around the knee.
The conclusion of the article was, “Applying ice for more than 30 minutes, and preferably for not more than 20 minutes, should be strictly avoided.” 5
After you sprain your ankle, this immune response can last for up to 1 week… Since, ice reduces the levels of IGF-1, we would expect to see muscle regeneration slow down.
Therefore, it is no surprise that a recent study concluded that ice appears to delay the return to normal of muscle damage markers. 6
Put together, these results indicate that using ice on an injury disrupts the body’s normal and healthy response. 7
ICE CAN BE HARMFUL TO ATHLETIC PERFORMANCE
A study done 2009 looked into the effect of cold-pack application on hormones on young elite handball players.
Various anabolic hormones, catabolic hormones and anti-inflammatory cytokines were reviewed.
The twelve male players performed 4 × 250 meter treadmill run, at 80% of each individual’s maximal speed, followed by a rest period with and without local cold-pack application.
Pre, immediately post, and 60-min post-exercise blood samples were drawn.
The results? Local ice therapy immediately following sprint-interval training was associated with greater decreases in both pro- and anti-inflammatory cytokines and anabolic hormones supporting some clinical evidence for possible negative effects on athletic performance. [REF]Nemet D, Meckel Y, Bar-Sela S, Zaldivar F, Cooper D, Eliakim A. Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: a prospective comparative trial. European Journal of Applied Physiology. November 2009, Volume 107, Issue 4, pp 411-417.[/REF]
Another study Mirkin cited was in Sports Med, Nov 28, 2011 which stated, “Ice is often used as short-term treatment to help injured athletes get back into a game.
The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination.”
Mirkin goes on…”In this review, a search of the medical literature found 35 studies on the effects of cooling.
Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running.”
PROLONGED REST DELAYS HEALING
Immobilization and prolonged rest are extremely harmful to the joints and ligaments.
While muscles are very strong and have good blood supply, ligaments are much weaker and have poor blood circulation.
After an injury, the ligaments lose water and glycosaminoglycans (which help maintain structure) so there is a net loss of mass in the ligaments and degradation of collagen.
This means that after an injury, the ligaments become MUCH weaker.
In one study, knee ligaments immobilized for even a few weeks showed that the ultimate load, linear stiffness, and energy-absorbing capacity of the ligaments to be reduced to about one third of normal.
In a review of 11 trials involving 868 ankle sprain patients, results showed that those who included early mobilization compared to those following the standard R.I.C.E. treatment reported a shorter sick leave with faster return to sport participation.
In addition, they showed less days missed from work with less visits to a clinic for follow-up, and improved range of motion with better functional scores.
ANKLE REHAB ENHANCES LYMPHATIC DRAINAGE (REMOVAL OF WASTE & FLUID FOR THE ANKLE)
In other words, the swelling in your ankle traps waste and unhealthy blood. Since, the ligaments do NOT have good circulation, it is essential that we improve the healthy blood supply to the ankle.
Improved circulation gets the unhealthy fluid out and healthy blood and nutrients into the injury to help it heal fully and quickly.
The primary way the body achieves this goal of removing waste from the injury is through a process called lymphatic drainage.
Researches found that ice forced this fluid ‘in the wrong direction’ (back into the ankle), increasing the amount of local swelling and pressure and potentially contributing to greater pain. 8 That’s really BAD!
So, what helps lymphatic drainage the right way? Well, optimal lymph flow is effectively controlled by multiple factors including lymphatic muscle contractions. 9
In other words… ankle rehab, not prolonged rest is essential for proper removal of waste from the injury. We are talking about safe, gentle and effective rehab system that builds up the ankle step by step.
Unfortunately, most people either rest their ankle too long or use random exercises they find on the internet which may not be the right exercises for them and they may not use the correct form.
The key is to follow an excellent program that will safely and actively rehabilitate the ankle for short and long term results.
ANKLE REHAB IMPROVES ATHLETIC PERFORMANCE
After an ankle sprain, there is a lot of damage to the ligaments. They become weak, unstable and may even have scar tissue and neuromuscular damage.
Prolonged rest will ensure that your ankle has great difficulty regaining its pre-injury strength, stability and range of motion, because it does NOTHING to deal with this damage.
The only way to effectively get your ankle back to full strength is through a good ankle rehab program that can strengthen and stabilize the ankles as well as heal the neuromuscular damage and break up and remove the scar tissue.
According to research, “the effectiveness of the rehabilitation program after injury often determines the success of future function and athletic performance. Range of motion, muscular strength, power, and endurance must be returned to pre-injury levels so that full, asymptomatic functional activities may be performed to the pre-injury level and beyond.” 10
ANKLE REHAB LOWERS THE RISK OF RE-INJURY
If you do not follow a good ankle rehab program, your ankle will also be at a higher risk of re-injury, since it will stay weak and unstable putting you at risk for more sprains with impact on the ground or unstable surfaces.
In fact, according to the Journal of Athletic Training:
“Adequate strength is necessary for normal movement patterns. The importance of developing correct motor patterns while subjects perform flexibility and strength exercises cannot be overemphasized.”11
Researches found that the risk of an ankle sprain was significantly lower if the ankles were stable within the normal limits.
In one study of127 soccer players, 42% of those who had unstable ankles got a sprained ankle versus 11% of those who had normal, stable ankles. 12
Again, only proper ankle exercises and stretches that build up ankle stability, strength and improve healthy range of motion can adequately heal the ankle and protect it from future injury.
If you found this article interesting, I hope you will share it.
Together, we can help others learn how to heal properly which will improve athletic performance, lower the risk of injury and help them avoid long term chronic pain.
- Mirkin G. Why Ice Delays Recovery. March 16, 2014. http://drmirkin.com/fitness/why-ice-delays-recovery.html. Accessed June 4, 2014. ↩
- Journal of Athletic Training 2013;48(4):528–545, doi: 10.4085/1062-6050-48.4.02 ↩
- Malone T, Engelhardt D, Kirkpatrick J, Bassett F. Nerve injury in athletes caused by cryotherapy. J Athl Train. 1992; 27(3): 235–237. ↩
- Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai C, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. J Strength Cond Res. 2013;27(5):1354-61. doi: 10.1519/JSC.0b013e318267a22c. ↩
- Drez D, Faust DC, Evans JP. Cryotherapy and nerve palsy. American Journal of Sports Medicine. 1981; 9:256-257. ↩
- Tidball JG, Wehling-Henricks M. Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo. J Physiol. 2007; 578: 327-336. ↩
- Tidball JG. Inflammatory processes in muscle injury and repair. Am J Physiol Regul Integr Comp Physiol. 2005;288:345-353. ↩
- The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986 ↩
- Dougherty PJ, Davis MJ, Zawieja DC, Muthuchamy M Am J Physiol Regul Integr Comp Physiol. 2008 May; 294(5):R1524-32. ↩
- Andrews J R, Harrelson G L, Wilk K E. 2nd ed WB Saunders; Philadelphia, PA: 1998. Physical Rehabilitation of the Injured Athlete. ↩
- J Athl Train. 2002 Oct-Dec; 37(4): 413–429. ↩
- Tropp H, Ekstrand J, Gillquist J Med Sci Sports Exerc. 1984; 16(1):64-6. ↩