When you first sprain an ankle, the injury will swell a lot. It will also bruise within the first few hours and most likely become very stiff and immobile. Depending on how bad you sprain it, you may not be able to put any pressure on it at all, or you may be able to walk with a limp. Either way, you will need to something to improve your chance for a quick and full recovery. If you do nothing, your sprained ankle could take months to heal and you may continue to have pain for a very long time.
So, what should you do first? Well, there are two sprained ankle treatment options available to you. The first is called R.I.C.E. It suggests you should rest and ice your ankle, keep some compression like a wrap on it and keep it elevated. It suggests you should continue to do this until you are healed. The second option is known as H.E.M. This ankle treatment suggests you should ice your ankle for the first 2 days, but also use more active rehab techniques including some very specific exercises, stretches and a few other healing methods. In short, one is non-active and the other is active. Which one works better? Let’s take a closer look…
According to H.E.M., you should ice the ankle just as in R.I.C.E., but with one big difference. H.E.M. suggests you only ice the ankle for the first 36-48 hours. (R.I.C.E. suggests you ice the ankle indefinitely until healed or until the swelling is gone, which can take weeks or months). What is the ice for anyway? Ice is used to help contain and reduce swelling. So, which way is better?
Interestingly, recent research has shown that ice is only effective for the first 48 hours after a sprained ankle. After that, it has not been shown to be clinically effective at reducing swelling. Accordingly then, it does make more sense to ice the ankle as H.E.M. advises and then move on to other healing methods.
The next difference between RICE and HEM is the subject of rest. RICE suggests rest until the ankle is healed. HEM differs greatly from RICE in this regard. Although HEM does suggest rest is an important component of healing, it does not believe that rest alone is the best way to heal an ankle. Instead, it promotes an active rehab program that entails a number of unique stretches and exercises as well as a few other effective healing techniques. However, just as in RICE, you will still be resting your ankle most of the time, since, when you are not doing the rehab in HEM, this ankle treatment suggests you rest your ankle. But, the main difference is that HEM believes that active rehab is absolutely necessary for a quick and full recovery versus rest alone.
Why does HEM insist on active rehab instead of pure rest? Well, research does suggest that there is usually extensive ligament damage in an ankle sprain. This means scar tissue can and usually does develop as well as some neuromuscular damage (the ability for the brain to communicate with the ligaments in the ankle) as well as general ligament weakness and stiffness. So, HEM goes about teaching you how to fully heal all this damage safely and correctly. And experts do agree that rest alone cannot remove or break up scar tissue, it cannot heal neuromuscular damage and it cannot improve range of motion of strength.
But, it is important to point out that HEM does not suggest any kind of dangerous movement or exercise. The exercises in HEM are very gentle, but powerful in helping the ankle safely regain its natural range of motion and strength. In addition, the stretches and exercises do also help reconnect the neuromuscular connection between the brain and ankle, so movement becomes smooth and safe again. And there are other techniques for helping you break up the scar tissue. So, HEM looks to fully heal all the damage from the sprained ankle injury. But, does it work?
Well, a good indicator is which treatment heals ankles faster? According to people who have used HEM, they are walking normally again and without pain in about a week or less. And according to people who use RICE, the average healing time is about 4-8 weeks. This would suggest that the body does react much better to the active rehab treatment versus the non-active one.
But, what we feel is even more significant is the following: the number of future sprained ankles fell sharply with the people who used HEM versus the people who use RICE. In other words, by strengthening the ankles and improving range of motion with HEM, people’s ankles were at a far lower risk of future ankle injury. We feel this is even more important than healing time, because it suggests that without a good, rehab program, the ankle is still at great risk of continually being injured and getting weaker and weaker over time.
So, in our opinion, HEM is a better and much more comprehensive treatment option than RICE. It seems to achieve better and longer lasting healing benefits than rest and ice alone.