Rob's Swollen Ankle
Updated: Sep 3, 2018
Just over 10 years ago I injured my ankle pretty badly. After several x-rays it was concluded my ankle was broken... then not broken... then not sure... before finally settling on 'not broken, very, very badly torn ligaments.’
Whether it was broken or not, my ankle was very swollen and I was told to follow the RICE protocol in the meantime.
RICE stands for: Rest, Ice, Compression and Elevation.
Rest and ice was the part I was to focus on: 'Keep it still and ice the swelling three or four times a day.'
This is seemed like good advice at the time, so when I heard about a book that was saying ice and rest was absolutely not the right way to treat a swollen joint, and that the perpetuation of this treatment method was slowing the healing of swollen joints around the world, I was intrigued...
The Ice Part of RICE
Ice is the common go-to treatment for swollen joints, bumps and bruises and has been for a long time.
From my personal experience of injuries in the past and from being involved in sports since the age of 5, I've seen a lot of ice-packs and heard 'best get some ice on it' on many occasions.
So when I heard about a book that was suggesting there is actually little to no evidence that shows ice helps reduce swelling I was more than a little intrigued.
My interest was piqued even further when I read this quote from Dr. Gabe Markin, the person who coined the 'RICE' term:
“Almost 40 years ago I coined the term RICE as the treatment for acute sports injuries. Subsequent research shows that rest and ice can actually delay recovery. Mild movement helps tissue to heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. So, today (29th August, 2014), RICE is not the preferred treatment for an acute athletic injury.” Dr. Gabe Markin
I decided to investigate and read the book...
As fate would have it, shortly after finishing the book, five-a-side football sensation Rob Kettle injured his ankle, and it swelled up pretty badly.
Rob went to Accident and Emergency and was told to follow the RICE protocol… hmmm.
Rob's Swollen Ankle
I told Rob about the book I'd just read and directed him towards a few videos on the topic.
Being the open minded man that he is, Rob tried following the advice of Dr. Gabe Markin, Gary Reinl and Dr. Kelly Starrett,. Their advice for swollen joints was to avoid ice, keep the joint moving as much as possible and compress the swollen area with a 'Voodoo Wrap' three or four times a day...
The results were pretty good; Rob’s ankle swelling went down pretty quickly.
Whether the quick reduction in swelling was because of the voodoo wrapping, the attempts to keep the ankle moving, not using ice or just pure coincidence is debatable.
However, if 'ICED!' is to be believed, Rob's ankle would have taken much longer to heal if he'd gone down the RICE route...
I made it clear to Rob that I was quite keen to use him as a lab rat for the method I’d read about in a book — even if it could potentially hinder his healing process — for the sake of a blog article.
Here are some quick answers (paraphrased from 'ICED!') to the questions Rob asked - and that you might also be wondering about.
(All the information is paraphrased from Gary Reinl's 'ICED!', which I recommend reading…)
What happens when you ice your swollen ankle?
Ice slows everything down. It slows down circulation and delays the inflammatory response. Basically, ice temporarily delays the healing process.
Ok, so what does this mean?
It means that your body has figured out you are injured and is trying to send its best weapons (chemical messengers, circulating body tissues) to help clean up and repair the injury, but ice is stopping them from getting there. Healing agents that are trying to get to the injury to help out are stopped in their tracks by the ice’s slowing down effect on circulation and the inflammatory response.
But isn’t reducing the inflammatory response a good thing? No, the inflammatory response is crucial to cleaning up and repairing the injured site; it’s crucial for healing. Without inflammation there cannot be healing.
Aren’t swelling and inflammation the same thing?
Swelling and inflammation are not the same thing. Swelling is the accumulation of fluid/waste at the end of the inflammatory cycle. The fluid is necessary as it means the inflammatory response is doing its job, but you don’t want the fluid to stick around (the fluid sticking around is the swelling). The ideal situation is for the the fluid to get there as quickly as possible and then to leave as quickly as possible – the swelling needs to be drained away.
But if ice stops everything, won’t it stop swelling as well?
Nope, it just delays it. Swelling is the end result of the inflammatory process, so when your body heats up again it’ll get right back to where it left off, swelling up just as much as it would’ve done. The ice will numb the pain but it won’t stop swelling from occurring, it will just delay it.
But I need to get rid of the swelling, right?
Correct, a bowling ball ankle is no use to anybody but the swelling itself isn’t the issue, it’s the evacuation of the swelling that is. The swelling needs to be cleared. After all, it’s difficult for a doctor or physio to know what’s going on until the swelling has disappeared…
So how do I get rid of the swelling?
Getting rid of swelling is like opening the drain after having a bath; if you don’t actively open the drain then the water (fluid/swelling) will stay there.
Movement and compression are like opening the drain, they actively drain the swelling away. So, keep your ankle moving as much as you can; if there is no movement, the swelling stays.
Compress the area using a voodoo band and move your ankle around whilst it’s compressed; this essentially squeezes the swelling away, kind of like toothpaste being squeezed out of the tube.
My ankle is too sore to wrap or move…
Firstly, get an x-ray to make sure it’s not broken.
Secondly, if your ankle is too sore to move, then try to move it a teeny tiny little bit and then a teeny tiny little bit more, progressively increasing the movement.
Alternatively, you could try a powered muscle stimulator to activate the surrounding muscles which will help squeeze the swelling away.
Key Points from 'ICED! The Illusionary Treatment Option'
• If the aim is to reduce swelling, don’t use ice. Ice will numb pain temporarily but won’t do anything to promote the clearing of swelling or the healing process, it will delay it.
• Keep your ankle moving as best you can and compress it using a 'voodoo band'.
• Icing cuts off the connection between circulating healing tissues and the injured tissues, this is not good; remember, inflammation is key to healing (so avoid anti-inflammatory drugs as well!)
Because icing has been done for so long and is so widely used and prescribed as a treatment, it's easy to be skeptical of information suggesting it isn't useful or even at all effective! I was too, and I spent a lot of time as a young athlete icing various knocks, bumps and bruises so was pretty intrigued to discover I may have actually been slowing the healing process!
Since reading 'ICED!' I've spoken to physiotherapists, sports therapists and doctors about the topic and have received mixed responses — some think 'ICED!' makes some great points and perhaps ice should not be used to reduce swelling, whereas others don't agree at all. Personally, I believe there is something to the theories in 'ICED!' and encourage anyone interested in the topic to read 'ICED!' and research the topic further.
ICED! The Illusionary Treatment option by Gary Reinl
For More Detailed Information
• Check out “ICED! The Illusionary Treatment Option” by Gary Reinl.
• Check this interview where Gary Reinl discusses icing: https://www.youtube.com/watch?v=0UmJVgEWZu4
• Check here to learn how to Voodoo band: https://www.youtube.com/watch?v=drTxhTcvLgU
Information used in this article is from “ICED! The Illusionary Treatment Option” by Gary Reinl.