From the Guidelines
The initial treatment for a ligament sprain should follow the RICE protocol: Rest, Ice, Compression, and Elevation, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
Key Components of Treatment
- Rest the injured area to prevent further damage and allow healing.
- Apply ice for 20 to 30 minutes per application, without direct contact on the skin, to reduce swelling and pain, as suggested by the guidelines 1.
- Use a compression wrap to promote comfort after an injury, but ensure it's not too tight and does not compromise circulation 1.
- Elevate the injured area above heart level when possible to help reduce swelling.
Pain Management
- Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation, but should be taken with food to minimize stomach irritation.
- Acetaminophen (Tylenol) can address pain but won't reduce inflammation.
Importance of Recent Guidelines
The 2024 guidelines 1 provide the most recent and highest quality evidence for the treatment of ligament sprains, and should be prioritized over older studies.
Considerations for Severe Sprains
Severe sprains may require medical evaluation to rule out fractures or complete tears requiring more advanced treatment, as noted in the guidelines 1.
From the Research
Initial Treatment for Ligament Sprain
The initial treatment for a ligament sprain typically involves the RICE therapy, which stands for rest, ice, compression, and elevation.
- Rest: Avoid activities that cause pain or put stress on the ligament.
- Ice: Apply ice to reduce pain and inflammation.
- Compression: Use a bandage or wrap to compress the affected area.
- Elevation: Elevate the affected limb above the level of the heart to reduce swelling.
Evidence for RICE Therapy
Studies have investigated the effectiveness of RICE therapy for ankle sprains, but the evidence is limited.
- A study published in the Journal of Athletic Training in 2012 found that there is insufficient evidence to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults 2.
- Other studies have focused on knee ligament sprains, providing guidelines for physical therapist practice 3, 4.
Conservative Treatment
Conservative treatment, including RICE therapy, is often recommended as the first line of treatment for ligament sprains.
- A systematic review published in the European Review for Medical and Pharmacological Sciences in 2022 found that conservative treatment provides satisfactory functional outcomes without the risks and costs of surgery 5.
- The review also suggested that flexible braces may be preferred over rigid braces, as they allow for an earlier return to daily activities.
Rehabilitation Protocols
Rehabilitation protocols for ligament sprains are varied, and there is limited evidence to support a specific protocol.
- A study published in the Journal of Orthopaedic and Sports Physical Therapy in 2021 provided revised guidelines for the treatment of lateral ankle sprains, but did not specify a particular rehabilitation protocol 6.
- Further research is needed to determine the most effective rehabilitation protocols for ligament sprains.