What is the recommended treatment approach for an ankle sprain?

From the Guidelines

The recommended treatment approach for an ankle sprain is functional treatment, which includes exercise and functional support, rather than immobilization, as it is preferred over immobilisation and leads to faster resumption of work and daily life activities 1.

Initial Treatment (0-72 hours)

• Limit weight-bearing on the injured ankle and use crutches if needed for moderate to severe sprains
• Apply ice packs for 15-20 minutes every 2-3 hours to reduce swelling and pain
• Use a compression bandage or elastic wrap to provide support and reduce swelling, but ensure it's not too tight
• Elevate the ankle above heart level whenever possible
• For pain management, over-the-counter medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg every 12 hours) can help reduce both pain and inflammation, while acetaminophen (500-1000mg every 6 hours) addresses pain only 1

Rehabilitation and Prevention

• After the initial acute phase (48-72 hours), begin gentle range-of-motion exercises and gradually progress to strengthening exercises like ankle circles, alphabet tracing with the foot, and calf raises
• Exercise therapy should be started as soon as possible to recover joint functionality, and for recurrent ankle sprains, exercise should be included in regular training activities as much as possible 1
• Functional support, such as a brace, is preferred over immobilisation, especially for prevention, and choice of modality should always be based on patient preferences 1
• Ankle braces should be considered as an efficacious option for the prevention of recurrent lateral ankle sprains 1

Important Considerations

• Surgery should be reserved for patients that require quick recovery, such as professional athletes, or whose complaints are not resolved by conservative treatment to avoid unnecessary invasive treatment on patients that would just as well recover from conservative treatment 1
• NSAIDs may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process 1

From the Research

Week-by-Week Treatment for Ankle Sprain

The treatment approach for an ankle sprain can be broken down into several components, including:

• Acute phase (0-7 days): The focus is on reducing pain and inflammation, with the use of ice, compression, and elevation [ 2 ]. Patients are advised to walk within the limits of pain.
• Subacute phase (7-14 days): The emphasis shifts to progressive weight-bearing and walking, with the addition of therapeutic exercises to improve ankle mobility and strength [ 2 ].
• Rehabilitation phase (2-6 weeks): This phase involves a gradual progression of exercises to improve ankle function, including balance, proprioception, and agility training [ 3 ].

Recommended Treatment Approaches

The following treatment approaches are recommended for ankle sprains:

• Early ambulation: Encouraging patients to walk and bear weight as soon as possible after injury [ 4 ].
• Manual therapy: Using techniques such as massage and joint mobilization to improve ankle mobility and reduce pain [ 4 ].
• Cryotherapy: Applying ice to reduce pain and inflammation [ 4 ].
• Functional supports: Using braces or orthotics to support the ankle and improve function [ 4 ].
• Rehabilitation: Implementing a comprehensive rehabilitation program to improve ankle strength, mobility, and function [ 3 ].

Prevention of Recurrent Sprains

To prevent recurrent ankle sprains, the following strategies are recommended:

• Bracing: Using a brace to support the ankle and prevent excessive movement [ 3 ].
• Neuromuscular training: Implementing exercises to improve ankle proprioception and neuromuscular control [ 3 ].
• Exercise therapy: Engaging in regular exercise to improve ankle strength and mobility [ 3 ].