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Posted on 11-03-2015

Ankle Sprains: Why M.E.A.T. and not R.I.C.E.??

Why are we talking about food when it comes to an injury? Turns out, it’s not actually food, but instead we are referring to the protocols used immediately following an injury. More specifically, an ankle sprain. The most common ankle sprain that we suffer is called an inversion sprain. This normally occurs when your foot rolls inward or medially, causing pain and a majority of times swelling, at the outside of your ankle. There are three main ligaments on the outside or lateral portion of your ankle that can be involved in a sprain injury: the anterior talofibular ligament, calcaneofibular ligament, and the posterior talofibular ligament. The majority of inversion ankle sprains involve the anterior talofibular ligament. The calcaneofibular and posterior talofibular ligaments can also be involved, but are less frequently injured. The severity of ankle sprains can vary from a mild stretching of the ligaments to a complete rupture or tear.  

The biggest initial concern with an ankle sprain is the risk of a fracture. To determine if X-rays are necessary, we utilize what are called the Ottawa Ankle Rules. 


  • Tenderness on the lateral or medial malleolus 
  • Tenderness on the base of the fifth metatarsal or navicular 
  • Inability to bear weight immediately or at time of examination


If any of these findings are positive, it is recommended to have an ankle/foot X-ray taken to determine if a fracture is present. While negative findings don’t completely rule out a fracture, the Ottawa rules are very good at helping to rule out a fracture following a severe sprain injury.

Once it has been determined that there is not a fracture, we can begin treatment. A common treatment method for treating ankle sprains is the RICE protocol, which stands for rest, ice, compression, and elevation. While the RICE protocol has become a main-stay for ankle sprains, its effectiveness has recently been called into question. A review in the Journal of Athletic Training found limited evidence to support the use of rest, ice, and compression for ankle sprains in adults. Many other articles have looked at the effectiveness of ice, specifically, and have found either insufficient evidence or a lack of effectiveness for the treatment of soft tissue injuries.  

An emerging protocol for ankle sprains is the MEAT method: Mobilization, Exercise, Analgesics, and Treatment. 


As opposed to the RICE protocol, which calls for resting the injury, early mobilization is encouraged when utilizing the MEAT method. Mobilization of the ankle promotes a quicker return to play and also helps to reduce the swelling occurrence. Depending on the severity of the ankle sprain, a brief period of rest may be necessary, refer this question to your chiropractic physician if you are unsure. One example of an early mobilization drill would be “the ABC/123’s” using your foot, act as if your toes are the tip of a pen, and draw each letter in lower and upper case and then the numbers 1-10. Ask your chiropractic physician for other examples of mobilization type exercises that can be utilized during an ankle sprain.


Once tolerable, beginning to exercise on the ankle can increase blood circulation to the area (which helps with healing) while strengthening the ligaments and muscles surrounding the ankle joint. While the traditional thera-band strengthening exercises are a good place to start (especially if movement is limited), balance or proprioception training along with functional training should be the emphasis. Wobble boards and balance beam training are some of the exercises that could be used to improve balance and proprioception in the early stages of injury. 


While analgesics won’t do in regards to healing the tissues or preventing another ankle sprain, they will decrease the pain which will make the short-term more tolerable. It is important to note that NSAIDS such as aspirin and ibuprofen have been shown to reduce tendon and ligament healing. Short term use of acetaminophen (Tylenol) may be a better choice as an analgesic. 


There are plenty of options for the treatment of ankle sprains. Manual and instrument-assisted soft tissue therapies are a great place to start (we utilize both Active Release Technique and Graston Therapies in our office). These therapies can help reduce the amount of swelling and restore the proper biomechanics in the ankle, while decreasing the chance of scar tissue buildup. The addition of RockTape to an ankle sprain will also decrease the amount of swelling. Joint manipulation to the ankle can also facilitate proper biomechanics and improve proprioception, if utilized early on in the acute phase of injury). 

While ankle sprains are a common injury, proper care is important to prevent long-term problems. The first step in evaluating an ankle sprain is to rule out a fracture. Once the risk of a fracture has been ruled out, treatment can begin. Although the RICE protocol is a popular treatment method, it may not be as effective as previously thought. The MEAT method provides both short term pain relief as well as long term prevention from recurrent ankle sprains. If you have suffered from an ankle sprain, have your ankle evaluated by the team at West Loop Spine and Stability.

Courtesy of Dr. Travis Ahrens, Chiropractic Physician @ West Loop Spine and Stability

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