Should you wrap an injury?

Posted on November 24, 2011

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In the same vein of whether you should ice an injury and whether you should talk ibuprofen for an injury, this post will deal with another common thing people do after an injury. You just rolled your ankle on a curb; should you be wrapping the ankle? Aka adhering to the C in the RICE formula, “Compression.”

Unfortunately, there is very little out there on this topic. The few studies have confounding variables such as icing, elevation, no control group, etc.

Similar to the issue of icing there can’t be a placebo group either. You know whether or not your ankle is being wrapped. Those who report a benefit to wrapping their ankle might just be experiencing a placebo effect akin to it feels nice to wrap it, so my ankle is healing faster, feels better, etc.

Therefore, I’m going to try and tie various studies together to form a decent conclusion. I’m also going to say a few words on compression garments and performance since I’m actually asked about that fairly often. This might seem superfluous, but as we saw with icing injuries and taking ibuprofen, the answer isn’t always what you think.

The best study I can find on this topic is: Treatment of the Inversion Ankle Sprain: Comparison of Different Modes of Compression and Cryotherapy. (Click for link.)

Quick briefing on this study: Three groups of people who experienced ankle sprains were formed. One group wrapped their ankle with something similar to an ace bandage. The other used a u-shaped aircast with a particular icing procedure, and the third used a u-shaped aircast too, but a different icing procedure.

how to wrap a sprained ankle

Picture something like this for the u-shaped aircast. The u shape helps to compress the ankle joint more effectively. This would then be wrapped to make sure the horseshoe stayed in place.

Right off the bat you can see issues with this study. The study had a small sample size, there’s no control group (a group that didn’t use compression at all), and the confounding variable of icing is present. Fortunately though, we know that icing an injury doesn’t increase healing time or improve injury outcome. Therefore, the icing variable actually proves to not be an issue. We can then look at the differences between the compression groups.

The ace bandage group was able to return to a high level of function about 25%, or 3-4 days, slower than the aircast group. In the grand scheme of things we’re talking about roughly 15 days for the ace bandage group to return to a high level of function and 11 days for the aircast group. A difference I suppose isn’t going to make a big difference in most people’s lives. For some though, like athletes or people who work manual labor jobs, this might mean a lot for them.

Again, technically we can’t deduce wrapping an ankle sprain is better than not wrapping at all. Logically though, I think we can. At the very least the study shows that the type of compression, or wrapping, done to an ankle sprain makes a pretty profound difference. If the type makes a difference, I’m willing to say just the fact that it’s done is beneficial.

Why it’s beneficial is up for debate though. The authors propose the aircast method of compression helps get rid of swelling better than the generic ace bandage. I’ll add and because of this reduction in swelling, those who received the aircast are more likely to move the ankle around more.

How much people mobilize their ankle (or injured site) after a sprain (or injury) makes a big difference in how quickly they return to activity. The idea of just rest is typically very, very bad advice.

In other words, if you were somehow able to measure how much the aircast group moved their ankle and took a non-aircast group, but had them move their ankle the same amount (having to work through the swelling and pain), I don’t think there would be much of a difference between the groups.

Regardless though, compressing an injury certainly isn’t hurting things. If it’s doing anything, it’s definitely helping.

Performance / Recovery

There is quite a bit written about this on the internet so I’m only going to say a few words. People consistently say is there is conflicting evidence over whether wearing compression garments, like compression shorts or tights, help muscle performance and or recovery. Some studies say it does, some say there’s no difference.

The cynic in me first says to find out where the pro-garment studies are receiving their funding from. I highly doubt a study funded by, say Nike, is going to say wearing their 90 dollar compression shorts doesn’t do anything beneficial. Let’s ignore that though.

The most glaring issue between the conflicting studies is that some studies use untrained people and some studies use trained people. This is a pretty common issue between muscle performance / recovery literature. The issue being untrained and trained people respond differently.

Studies using untrained people find compression gives a great benefit. For example: this study found untrained people experienced less arm soreness and better function when using a garment.

(Similar to the aircast study above, this study found quite a big difference between the function of the compressed arms and the non-compressed arms. Again though, I would love to see how much the compressed group moved their arm throughout the 5 day follow-up period. I’d be really surprised if they didn’t move their arm considerably more due to the comfort of the garment.)

In contrast, studies using trained people don’t find anything noteworthy. These two studies,  here and here found no differences between trained people who wore a garment versus those who didn’t.

Why the contradictions? My theory is the compression will only elicit a benefit if the inflammation / swelling is dramatic. There’s some threshold of swelling that needs to occur in order for the compression to cause a response.

Exposing untrained people to intense bouts of eccentric exercise can produce a hell of a lot of inflammation. Not as much as an ankle sprain, which we already saw compression benefits, but still a lot. Surely a lot more than a trained person, people who really shouldn’t be getting very sore, if at all, are going to experience. Therefore, untrained people and people with acute injuries -people who experience a lot of inflammation- receive a benefit. Others do not.

So compression garments are beneficial for injuries but aren’t doing much for exercise performance and recovery. The fact that compression feels good is probably doing more than anything physiological. That doesn’t mean it’s not beneficial though. The placebo effect can be quite strong. Whether it’s placebo or something physiological, there aren’t any drawbacks, so why not take advantage of it?

So don’t bother wasting money on those Underarmor tights, but keep wrapping those ankle sprains. Just make it focal on the injured site as that seems to be much better than your generic ace bandage wrap.

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Posted in: Pain