RICE: Taping and Bracing an Ankle?

Because most sporting events involve running, it is inevitable that an athlete will suffer from an ankle sprain some time in his/her athletic career. Because of the poor blood supply to the ligaments, ligament injuries often linger, even though a great deal of the initial pain subsides. The athlete eventually goes through physical therapy, exercises, and NSAIDs but continues to experience ankle pain and clicking in the joint. Athletes are often told that the ankle pain will respond well to cortisone injections. The athletes proceed to get a series of these shots. Because the cortisone shots cause a decrease in the pain, the athletes then return to their athletic events, not knowing that the cortisone is making the ligaments weaker. Playing on a ligament that is ever-decreasing in strength is not the best idea.

When the cortisone wears off, the ankle clicking increases. The orthopedist, podiatrist, or athletic trainer then notices that the athlete has chronic ankle instability. They, of course, do not tell the athlete that the instability has occurred because of the RICE treatments, NSAIDs, and the cortisone shots because they inhibit the body's ability to heal soft tissue injuries. Generally at this point, the athlete is put into a cast for up to six weeks to "allow the ligament to heal."

Casting or any kind of imposed immobility is the worst advice for healing ligaments, muscles, joints, or bone unless a fracture is involved. Immobilization, whether by casting, non-use, or bracing, is extremely detrimental to the joints and ligaments.

Immobilization causes the following changes to occur inside joints:
1. Proliferation of fatty connective tissue within the joint
2. Cartilage damage and necrosis
3. Scar tissue formation and articular cartilage tears
4. Increased randomness of the collagen fibers within the ligaments and connective tissues
5. Ligament weakening with a decreased resistance to stretch (1,2)

Studies performed on animals reveal that after only several weeks of immobilization, the strength of ligament tissue was reduced to about one-third of normal.(3-5)

Immobilization or casting also significantly decreases the strength of the fibro-osseous junction, the bone-ligament interface.(3)

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