From the Guidelines
The acute management of a high-grade ankle sprain should prioritize functional treatment, including early mobilization and exercise therapy, over immobilization, as it stimulates the recovery of functional joint stability and reduces the risk of chronic instability 1. The management of a high-grade ankle sprain involves several key components, including:
- Protection of the ankle with a brace, air cast, or elastic bandage to prevent further injury
- Relative rest, avoiding weight-bearing for 24-48 hours, then gradually introducing partial weight-bearing with crutches as tolerated
- Pain management with acetaminophen or NSAIDs, such as ibuprofen, for 3-5 days, while avoiding NSAIDs in the first 24-48 hours to prevent impairment of healing
- Early mobilization and exercise therapy, including gentle range-of-motion exercises and progressive strengthening exercises, under the guidance of a physical therapist, to promote optimal tissue healing and restore function The use of RICE (Rest, Ice, Compression, and Elevation) is not recommended as a treatment modality after a lateral ankle sprain, as its efficacy is unclear and it may not provide additional benefits compared to other treatment modalities 1. Functional support, such as the use of a brace, is preferred over immobilization, and exercise therapy should be started as soon as possible to recover joint functionality 1. Surgery should be reserved for patients who require quick recovery or whose complaints are not resolved by conservative treatment, to avoid unnecessary invasive treatment and risk of complications 1.
From the Research
Acute Management for High-Grade Ankle Sprain
The acute management of high-grade ankle sprains involves several key components, including:
- Rest, ice, compression, and elevation (RICE) therapy, although the evidence for its effectiveness is limited 2
- Non-steroidal anti-inflammatory drugs (NSAIDs) and early mobilisation, which have strong evidence for reducing pain, swelling, and improving function 3
- Exercise and manual therapy techniques, which have moderate evidence for improving outcomes 3
- Bracing and neuromuscular training, which have strong evidence for preventing recurrence of ankle sprains 3
Treatment Strategies
Treatment strategies for acute ankle sprains may include:
- Cryotherapy 4
- Functional supports 4
- Early ambulation 4
- Short-term NSAIDs 4
- Rehabilitation 4
- Manual therapy 4
Clinical Evaluation and Diagnosis
A thorough clinical evaluation is necessary to ensure an accurate diagnosis and appropriate treatment prescription 5. Understanding the types of ankle sprains, including high (syndesmotic) ankle sprains, is essential in determining the most appropriate treatment and preventing substantial missed time from sports 6.
Prevention of Recurrent Sprains
Strategies for prevention of recurrent sprains and return to play considerations are also important aspects of acute management 5. Exercise therapy and bracing are supported in the prevention of chronic ankle instability (CAI) 3.