is R.I.C.E. right?

Whenever we strain or sprain a muscle, we immediately start applying R.I.C.E (rest, ice, compression, and elevation), but is that the right thing to do?

The RICE and PRICE (protection, ice, compression, and elevation) practice came from good old medical guess work and reasoning more than actual research studies. The new studies are showing that these regimens are not the best way to speed your way back to doing what you love to do.

Let’s start with the protection and rest portion. There was a study completed in 1994 by Oregon Health and Science University. The study took 82 people with sprained ankles and divided them into two groups one group had their ankle immobilized for 10 days and then began exercises to increase mobility. The other group wrapped their ankle for two days and then began the same program. The second group was back to doing their thing much faster: 57% back to it, where the immobilization group was only at 13%.

Complete rest is not the best option for many sprains, but be smart. If you can walk on it, take it easy, but don’t completely stop. Let pain be your guide. If the pain gets worse stop. If the pain is higher than a 2.5 on a one to five scale tone it down so it’s only a two. You may have to give it 48-72 hours before you can begin, but doing some activity is better than doing nothing. It’s called active rest.

Okay so the total rest or complete protection of the joint isn’t a good thing. What about the ICE? There’s no research that shows it actually reduces swelling. It only delays it. It is a good pain reliever and the theory was that if there is less pain you’re going to be able to move it sooner. The problem is it is delaying recovery by delaying the inevitable swelling. It also delays a hormone called IGF-1, which is key in repairing damaged tissues.

And compression? Well, there’s not research, but the doctors know it reduces swelling and if swelling is down, you are able to move your joint better and sooner. Elevation to reduce swelling? Um no. It may reduce it while it’s elevated, but as soon as you put it down the swelling returns.

So what do we do? A.R.I.T.A.: active rest is the answer. Implement active rest. Start with some basic mobility exercises while keeping your pain level down. It doesn’t have to be pain free. Do things that keep the joint mobile but don’t hurt to do. Sometimes it’s the side to side strain that causes pain but forward and back is fine.

You can’t let the muscles sit idle because they tighten up and atrophy. Scar tissue builds up which will then impact the movement of tendons and muscles for a long time if not forever. Continuing motion of the joint/muscle ensures the healing process will begin and be effective.

Trail Runner Road Running?

As a trail runner, I have looked at road runners with curiosity, especially those that run canyon roads. I always wonder why would you run on the road if you are right by a beautiful trail?

Is there a place for road running in a trail runners training? Yep. There are a number of reasons to run on the road as a trail runner. It’s not ideal and I try to avoid it when I can.

On vacation, it can be difficult to find nearby trails where you can get your daily dose of running, but you definitely don’t want to skip your run, so you head out on the road. Another reason to run on the road while on vacation is if you are in a place where the city because of buildings or culture is an attraction. There’s no better way to explore than running up and down streets.

Winter can be a challenging time to find trails clear enough of snow that they are runnable and not all runners take winter off or change to a winter sport. Road running in the winter poses its own challenges because it gets dark earlier and light later, make sure and take a headlamp, tail light, and reflective vest. You also need to watch for sliding cars.

Convenience is another one. Sometimes you just don’t have time to get to the mountain, but you need to run. Runners are busy people with family and work obligations. Fitting in a run can be a challenge some days. It’s okay to run on the road when you’re short on time. The trail will still love you.

Supporting a fellow runner. Beginning runners can be hesitant to jump right to trail running. If you’re pulling someone into running. Running on the road is permissible, in fact, supporting a fellow runner who is running the road is pretty much always permissible. Trail runners are some of the most community oriented runners who would give you their last drop of water or piece of food on the trail.

Recovering from an injury, especially one involving twisting of a joint. The uneven surface, rocks, roots, and river crossings ubiquitous in trail running increases the risk of re-injury. Running on the even predictable surface of a road may get you back out running earlier than if you wait until your body is ready for a trail. And the earlier you can get back out there, the less fitness you lose.

Running on the road is different than running on trails, pretty obvious. I suggest road shoes rather than your trail shoes for a few reasons. The pavement will ruin your trail shoes and trail shoes have thinner bottoms than road shoes. If you are going to be running on the road for more than a week or two, think about grabbing a pair of road shoes.

Definitely invest in a reflective vest, headlamp, and tail light if you’re running in the dark. Cars need to be able to see you as early as possible. Wearing earbuds is also something to think about because you need to be able to hear the cars approaching you.

I know there is research out there that says your body adjusts to the surface you are running on and that there is the same impact to your body regardless of what you are running on, however, my experience is different. My muscles feel the road a lot more than the trail. I can run a fifty-mile race on trail and not be sore, but if I run a marathon on the road, I’m sore.

Ankle Sprains

Ankle sprains are a common occurrence among runners. Especially, trail runners. I recently sprained my ankle for the second time in ten years, not a bad record considering how much I run. I have lose tendons in my ankles anyway, so I can turn an ankle and not cause any damage 90% of the time. Two weeks ago, I was running down a mountain and another runner was coming up. I stepped up onto the slope of the mountain to avoid the runner and when I came down on my left foot it rolled over.

Pain shot up my leg and I heard it tear and said some choice words. I limped along for a bit, but was able to slowly run down the last little bit. I stopped at the first gas station, picked up ice and iburprophen. The swelling isn’t totally gone, but I think I’ll be back out on the mountain in another week.

True to form, I researched how to rehabilitate a sprained ankle and how long it takes to heal. During the acute phase injury to 3-4 days taking iburprophen, icing 4-5 times a day for 15 minutes each time, compression and bracing when you are walking on it.

There are three grades of ankle sprains. Grade one isn’t too bad maybe a minor tear and over stretching. It can cause some pain when walking and some swelling. This takes a week or two to get back to your activities. Grade two is a minor-moderate tear and over stretching. It causes swelling, bruising, pain, and imbalance. It takes 3-4 weeks before you’re back to your activities. Grade three is severe or complete tear of the tendons, which may make surgery necessary. You’ll definitely need crutches to get around. Recovery time on this one is going to be six to eight weeks at a minimum.

Rehabilitating any injury requires strengthening the muscles and tendons that were injured and then the surrounding and supporting ones, balance and proprioception and maintaining mobility. Physical therapy/rehab exercises should begin as soon as you can do them without zero to minimum pain (2 or lower on a 1-10 scale). Exercises should continue for three to four months.

Start mobility exercises about 4-10 days after. Move the foot forward and back, start ankle rolls and writing the ABC’s with your big toe, heel on the floor. You also want to stretch your Achilles and calf muscles.  For strengthening, use an exercise band. Wrap it around your forefoot and pull it to the outside, inside and away from you. You can also do this against a wall. Calf raises are also good.

For the balance piece, start slow and work your way up: standing on one leg on the floor, then with your arms out and bent over, and finally using a balance board. To reestablish the brain body communication (proprioception) write the ABC’s with your whole foot while balancing on one leg.

Be patient in your recovery. Once you roll an ankle it is easier to do it again in the future, which is why continuing the exercises for three to four months is so important. When you do return to running, tape your ankle (youtube) each time you run for a week or two. You’ll have to reduce your miles and build them up to reduce the risk of overloading the healing tissues.

You can cross train doing things that don’t cause any pain. Getting out there as soon as possible is important, but keep in mind, going out too soon poses a high risk for re-injury and starting from square one or causing more damage.