Effective treatment of an ankle sprain can be simplified if you can recall the acronym M.I.C.E.
During this four minute video Sam Voight, Marshfield Clinic licensed athletic trainer, explains the principles of M.I.C.E. as: motion, ice, compression and elevation. Each of these treatments helps control swelling in the ankle. Managing swelling has been proven to significantly improve the healing process.
Watch the M.I.C.E. First aid treatment for an ankle sprain on YouTube.
Share comments or questions on this information. E-mail sports.medicine@marshfieldclinic.org.
Transcript
The following is a complete transcript of the M.I.C.E. video provided for users who are hearing impaired.
An ankle sprain is one of the most common sports injuries. Proper initial first aid can mean the difference between a speedy recovery and being out of action for an extended time.
In the training room, we have found the proper first aid really includes the four treatments we find in the acronym M.I.C.E. "M" is for motion, "I" is for ice, "C" for compression and "E" for elevation.
"M" stands for motion.
Specifically dorsiflexion, or flexing the foot upwards. The idea is to get to this motion as quickly as possible after injury, but in a slow pain free manner, before swelling occurs, and once you get this motion, keep it.
If the ankle swells in full dorsiflexion, you may still be able to point your toes but, if the ankle swells with the foot pointed down in plantar flexion, it blocks the dorsiflexion motion and it may take a long time and be too painful to get the dorsiflexion back. It may be a little uncomfortable to dorsi-flex but it should be pain free. Never force motion that causes pain, this could be a sign of a fracture.
An inverted crutch or a belt or long towel can be used to help get and maintain dorsiflexion motion.
The "I" in MICE stands for ice.
Ice cubes in a plastic bag may be applied directly to the skin for a period of 20 minutes at a time. Ice treatments can be repeated in the 20 minutes on, hour off fashion throughout the day as needed to control pain and swelling. For those sensitive to cold, a thin cloth may be applied between the ice and skin. After 20 minutes, remove the ice and allow at least an hour for the skin to return to normal temperatures before applying ice again. Never apply heat to an acute injury as this will increase bleeding and swelling.
Here is a trick of the trade that helps to apply ice comfortably. Fill a plastic bag with only enough ice to lay the bag flat one to two cubes thick. Remove as much air as possible, twist and close or tie the bag securely. On flattening, this provides a lightweight ice pack that conforms to the site of injury.
The “C” in M.I.C.E. stands for compression.
Compression is used to hold the ice bag in place over the site of injury, and after icing to help keep the swelling to a minimum and provide gentle support to the ankle.
For proper application of a compression wrap, begin the wrap just behind the toes and spiral towards the heart, around the foot and ankle, overlapping by about half of the width of the wrap. Cover every bit of skin including the heel until you are several inches above the injury.
For additional support, heel-locks may be wrapped by starting just above the ankle bones on either side, progressing over the front of the ankle joint, wrapping under the arch at an angle that will take the wrap around the back of the heel and around the opposite ankle bone. This can then be repeated from the other side.
Be sure to check the circulation periodically with a gentle squeeze to the toes. The nail bed or skin should turn white and on releasing should return to a pink color within a second or two. Instruct the athlete that if their skin turns blue-ish, white/grey or turns cold, painful or numb the wrap may need to be loosened.
“E” is for Elevation.
Elevating an injury 12 to 18 inches above the heart significantly reduces the blood pressure to the injured tissues and decreases the amount of swelling after injury.
You’ll notice that each of these treatments help to control swelling. The research suggests that swelling alone significantly slows the healing process. Therefore if we can prevent swelling from happening or we can get it out of the tissue sooner, the faster it will heal.
Next time you are faced with a an ankle sprain, just "M.I.C.E." it.
"M" stands for motion, dorsiflexion, get it and keep it. "I" is for Ice 20 minutes at a time, hour off, repeated throughout the day as needed. "C" is for compression, and "E" is for Elevation, 12-18 inches above the heart.
