What is the treatment protocol for ankle sprain (lateral ankle ligament sprain)?

From the Guidelines

The most effective treatment protocol for an ankle sprain involves functional treatment in the form of exercise and functional support, such as a brace or tape, rather than immobilization, as recommended by the most recent and highest quality study 1. This approach is supported by the British Journal of Sports Medicine study from 2018, which emphasizes the importance of excluding fractures using the Ottawa Ankle and Foot Rules and then proceeding with functional treatment to promote healing and prevent future injuries. The treatment protocol should include:

• Initial assessment to exclude fractures using the Ottawa Ankle and Foot Rules
• Functional treatment with exercise and functional support, such as a brace or tape
• Avoidance of immobilization, except for a short period to reduce pain and swelling
• Mobilization therapy to improve range of motion, if necessary
• Surgery reserved for patients with lateral ligament ruptures
• Prevention of future ankle sprains through functional support and exercise therapy, particularly in patients with a history of recurrent sprains, as supported by the study 1. It is essential to note that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and other forms of therapy, such as vibration and electrostimulation, may have some benefits, but the evidence is limited, and their use should be approached with caution, as reported in the study 1. In terms of specific exercises, gentle range-of-motion exercises, such as ankle circles and alphabet tracing with the foot, can be started after the acute phase (48-72 hours), followed by strengthening exercises, including resistance band work and balance training, as the healing progresses, similar to the approach outlined in the American Family Physician study from 2006 1. However, the most recent and highest quality study 1 should be prioritized, and its recommendations should guide the treatment protocol for ankle sprains.

From the Research

Ankle Sprain Treatment Protocol

• The treatment of ankle sprains can be guided by several key principles, including the use of the RICE method (rest, ice, compression, and elevation) 2, as well as early mobilization and the use of non-steroidal anti-inflammatory drugs (NSAIDs) 3, 4.
• A systematic review of clinical practice guidelines for the management and treatment of ankle sprains found that six recommendations had enough evidence to be applied in clinical practice, including:
  • Ottawa rules
  • Manual therapy
  • Cryotherapy
  • Functional supports
  • Early ambulation
  • Short-term NSAIDs and rehabilitation 5
• The use of NSAIDs has been shown to be effective in reducing pain and swelling in the acute phase of ankle sprain treatment, with both oral and topical NSAIDs demonstrating superior results compared to placebo 3.
• Exercise therapy and bracing have been found to be effective in preventing recurrent ankle sprains, with strong evidence supporting the use of bracing and moderate evidence supporting neuromuscular training 4.
• A thorough clinical evaluation is necessary to ensure an accurate diagnosis and appropriate treatment prescription, and strategies for prevention of recurrent sprains and return to play considerations should also be discussed 6.
• The treatment of acute ankle sprains may also involve the use of early mobilization, exercise, and manual therapy techniques, with moderate evidence supporting their use in reducing pain, swelling, and improving function 4.