From the Guidelines
For an acute sprain or strain, ice is the best initial treatment, not heat, as it can acutely decrease pain and swelling, and should be applied for 20 to 30 minutes, 3 to 4 times daily, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Considerations
- The mainstay of treatment for strains and sprains is rest and limiting the use of the injured extremity, which avoids worsening the injury 1.
- Cold application, such as using a bag filled with ice and water surrounded by a damp cloth, can effectively cool the area and reduce pain and swelling, but it has not been demonstrated to improve function or time to recovery 1.
- Experts recommend limiting the duration of cold application to 20 to 30 minutes for 3 to 4 times daily, and ice should not be placed directly on the skin to prevent cold injury 1.
Treatment Approach
- The treatment approach should combine rest, compression (using an elastic bandage wrapped snugly but not too tight), and elevation of the injured area above heart level when possible, collectively known as RICE therapy.
- Over-the-counter pain medications like ibuprofen or naproxen can help manage pain and reduce inflammation.
- Heat therapy should be avoided initially, as it increases blood flow and can worsen swelling and inflammation, but it can be used after the acute phase has passed, typically after 72 hours, to promote healing by increasing blood circulation to the area.
Clinical Guidelines
- The Ottawa Ankle and Foot Rules provide clinical guidelines for excluding a fracture in adults and children and determining if radiography is indicated at the time of injury 1.
- Functional rehabilitation, such as motion restoration and strengthening exercises, is preferred over immobilization, and support devices can provide some protection against future ankle sprains, particularly in persons with a history of recurrent sprains 1.
From the Research
Treatment Options for Acute Sprain/Strain
- The use of non-steroidal anti-inflammatory drugs (NSAIDs) is recommended for the treatment of acute musculoskeletal pain, including sprains and strains 2, 3, 4, 5, 6
- Topical NSAIDs, such as diclofenac, ibuprofen, and ketoprofen, have been shown to be effective in providing pain relief for acute conditions like sprains and strains 5
- Oral NSAIDs, such as ibuprofen, have also been found to be effective in reducing pain and inflammation in acute musculoskeletal injuries 3, 6
Ice or Heat Therapy
- There is no direct evidence in the provided studies to support the use of ice or heat therapy as the best course of action for an acute sprain/strain
- However, the use of NSAIDs, either topical or oral, has been shown to be effective in reducing pain and inflammation, which may be a more effective treatment option than ice or heat therapy alone 2, 3, 4, 5, 6
Additional Considerations
- The treatment of acute sprains and strains should be tailored to the individual patient, taking into account the severity of the injury and the patient's medical history 2
- Early mobilization and exercise have also been shown to be effective in promoting recovery from acute ankle sprains 4
- The use of NSAIDs should be done with caution, as they can have adverse effects, such as gastrointestinal bleeding and cardiovascular disease 2, 3