From the Guidelines
Immobilization is generally not recommended for a grade one ankle sprain. Instead, functional treatment in the form of exercise and functional support, such as a brace or tape, is preferred over immobilization 1. This approach is supported by the British Journal of Sports Medicine, which recommends the use of functional support for 4–6 weeks, with the ankle brace showing the greatest effects compared to other types of functional support 1.
The main goals of treatment for a grade one ankle sprain include reducing pain and swelling, promoting healing, and preventing stiffness.
- The RICE protocol (Rest, Ice, Compression, Elevation) is a suitable initial treatment approach.
- For pain management, over-the-counter medications like acetaminophen or NSAIDs such as ibuprofen can be used for the first 24-72 hours.
- Early controlled movement and weight-bearing as tolerated are encouraged to promote healing and prevent stiffness.
- A simple elastic bandage or ankle sleeve may provide sufficient support while allowing movement.
- Physical therapy exercises focusing on range of motion, strengthening, and proprioception should begin within a few days of injury.
If immobilization is applied to treat pain or oedema, it should be for a maximum of 10 days, after which functional treatment should be commenced 1. This approach is recommended because grade one sprains involve minimal ligament damage without joint instability, and early controlled movement has been shown to promote better blood flow to the injured area, reduce swelling, and prevent muscle atrophy, ultimately leading to faster recovery and return to normal activities compared to rigid immobilization.
From the Research
Immobilization and Weight Restriction for Grade One Ankle Sprain
- Immobilization is not typically recommended for grade one ankle sprains, as it may worsen the range of motion (ROM) of the ankle and delay return to play (RTP) 2.
- Early mobilization is often preferred, as it allows for earlier return to work and may be more comfortable for patients 3.
- Limited immobilization may be used in some cases, but it should be followed by early return to weight bearing and range of motion, and directed physical therapy 4.
- Excessive immobilization and unwarranted non-weight-bearing are common myths and mistakes in the management of ankle sprains that should be avoided 5.
Treatment Approaches
- A comprehensive and progressive exercise program, including range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises, is recommended for the rehabilitation of ankle sprains 5.
- Bracing and early weight-bearing are also recommended, as they can help reduce the risk of recurrent injury and promote faster recovery 4, 5.
- Immobilization for a short period (one to two weeks) may be used in some cases, followed by physical therapy focused on peroneal proprioception and strength 6.