As it warms up outside and people become more active, we in the medical field see an increase in injuries, and sprains are a big one.

For years, those of us in Chinese Medicine have winced at the recommendation to use ice for sprains, since it goes directly against how our system approaches injury. But it has been the standard of care for about four decades, so our concerns mostly fell on deaf ears.

Recently, that’s started to change.

Coaches and trainers who work directly with professional athletes, who need to get back on the field as quickly as possible, began doing things differently. Because they prioritize fast recovery above all else, they started questioning conventional care. When they paid attention to what happened with and without ice, they found it actually slowed healing. Now, research is beginning to back this up.

What happens in a sprain

Ankle sprains are extremely common. In fact, it’s unusual for there not to be at least one during a game that involves running.

Ligaments are strong bands of tissue that connect bone to bone. They don’t have much flexibility, and they don’t stretch and contract like muscles and tendons. When a joint bends beyond its healthy limit, these fibers tear, and we call that a sprain.

Any joint can be sprained, though the most common are the ankle, wrist, knee, fingers, and toes. Many back injuries likely involve some degree of spraining as well, since the vertebrae are connected by small ligaments.

Sprains are classified by severity:

• First degree: minimal tearing and bleeding
  
  

• Second degree: partial tearing with significant bleeding under the skin
  
  

• Third degree: complete tear of the ligament
  

A third degree ankle sprain often requires surgery, but first and second degree sprains are usually managed with home care followed by rehabilitation.

The problem with R.I.C.E.

Traditional treatment for a sprained ankle (assuming it’s not a third degree tear) is R.I.C.E., which stands for Rest, Ice, Compression, and Elevation. This approach was introduced by Gabe Mirkin, MD, in 1978.

• Rest prevents further injury
  
  

• Ice reduces pain and swelling
  
  

• Compression limits swelling
  
  

• Elevation helps reduce fluid buildup
  

As you can see, RICE focuses heavily on reducing swelling. But swelling is part of the body’s natural healing response.

After an injury, the body sends a large influx of immune cells to the area. Ice and compression restrict circulation by constricting blood vessels, and elevation works against gravity to limit fluid flow. The result is that healing often takes weeks or even months, sometimes with lingering issues.

A different perspective

This approach never made sense to me because of a core principle of Chinese Medicine: all pain is caused by stagnation, and healing happens when flow is restored.

Every part of RICE works against that.

With a sprain, stagnation is very pronounced. The joint fills with fluid. While ice, compression, and elevation may slow the initial buildup, they’re based on the idea that the body is overreacting and needs to be stopped.

But the body isn’t doing something wrong.

It’s sending nutrients and a cleanup crew to the area. This inflammatory response is essential for healing. It just needs support to keep things moving.

Why movement matters

Much of the fluid in a sprained joint is cleared through the lymphatic system, which doesn’t have a central pump like the heart. Instead, it relies on muscle movement.

When muscles contract, they push fluid through the lymph vessels.

This means that complete rest, especially combined with ice and compression, can actually trap fluid in the joint. Studies now show that ice can slow drainage and even cause fluid to flow back into the surrounding tissue.

Supporting healing instead of slowing it down

In Chinese Medicine, we use tools that promote movement and circulation.

Acupuncture and heat both increase flow and can speed healing. While conventional advice often warns against heat because it “increases swelling,” what it really does is open circulation and keep the healing process moving.

Topical herbs can further support healing, and we also encourage gentle movement of the affected area. This doesn’t mean pushing through pain or risking further injury. It means staying engaged with the joint in a careful way.

Movement helps clear debris, bring in oxygen and nutrients, reduce scarring, and support stronger, more functional healing.

From R.I.C.E. to M.E.T.H.

Even Dr. Gabe Mirkin has since written about how ice may delay recovery.

With this in mind, many practitioners are moving toward a different way of treating sprains.

Instead of RICE, more trainers and doctors are beginning to use METH. And no, I don’t mean they’re taking amphetamines.

• Movement
  
  

• Elevation
  
  

• Traction
  
  

• Heat
  

Only elevation from RICE remains.

Some practitioners, like trainer Dick Hartzell, use techniques that combine traction with continuous movement. In many cases, recovery happens in minutes, hours, or days instead of weeks.

If you get a sprain

If you suffer a sprain, it’s important to get medical attention when needed.

Beyond that:

• Avoid ice and anti-inflammatory drugs when possible
  
  

• Keep the area gently moving (without bearing weight at first)
  
  

• Support circulation and flow
  
  

• Consider working with a skilled acupuncturist
  
  

Topical support, like the Muscle Melt formulas I developed, can also help encourage circulation in the area.

And be prepared to surprise people with how quickly your body can heal when it’s supported in the right way.

Be well,

Dr. Peter Borten