A 28-year-old recreational soccer player arrives at urgent care one hour after inverting her right ankle on uneven turf. She was able to bear weight after the injury and walked into the clinic with a limp. Ottawa ankle rules are negative. Examination shows lateral ankle swelling and tenderness over the anterior talofibular ligament without bony tenderness. You plan conservative management using the RICE protocol. According to RICE, which step should she prioritize FIRST at home over the next 24 hours?

Question

Accepted Answer

✅ A. Rest — avoid weight-bearing and aggravating activity
The "R" in RICE is Rest — the first step, starting immediately. Continued weight-bearing and pivoting motions can extend ligament damage in the acute phase. Rest is paired with protection (brace, crutches if painful) for the first 24-72 hours after a grade I-II ankle sprain with negative Ottawa rules.

❌ B. Ice
15-20 minutes every 2-3 hours, wrapped, not on bare skin
Ice is the "I" and is critical, but Rest is the first step listed in the mnemonic and the first behavioral change required — you have to stop stressing the joint before icing and wrapping matter. Direct ice on skin risks frostbite, so always wrap it.

❌ C. Compression — elastic wrap from toes upward
Compression is the "C" — important for edema control but applied after activity has stopped. Wrap distal-to-proximal, not too tight, and check cap refill and distal pulses.

❌ D. Elevation — keep the ankle above heart level
Elevation is the "E" — reduces edema by gravity. Helpful but a supportive measure rather than the initiating step. Combined with rest, ice, and compression it maximizes swelling reduction.

:::tip
If the patient cannot bear weight four steps or has bony tenderness at the posterior malleolar edges or navicular/5th metatarsal base, Ottawa ankle rules are positive — image first, then RICE.
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RICE

Clinical Context

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