From the Guidelines
The most effective treatment for a sprained ankle is functional treatment, which includes the PRICE protocol, exercises to restore motion and strength, and endurance training, as it has been shown to be superior to immobilization in terms of returning to sports and work sooner 1.
Key Components of Treatment
- The PRICE protocol should be initiated within 24 hours of injury to minimize pain and swelling, and includes:
- Protection of the ankle from further injury
- Rest and avoiding weight-bearing activities
- Ice to reduce pain and inflammation
- Compression with an elastic bandage
- Elevation of the ankle above heart level
- Exercises to restore motion and strength should begin within 48-72 hours of injury, and may include range-of-motion exercises and strengthening exercises
- Endurance training, sport-specific drills, and training to improve balance should begin when the second phase is well underway
Additional Considerations
- Over-the-counter pain medications like ibuprofen or acetaminophen can help manage pain and reduce inflammation
- Medical attention should be sought if you cannot bear weight, have severe swelling or pain, or if symptoms don't improve after a few days
- A semirigid brace may be indicated to facilitate return to work and provide protection against future ankle sprains
- Ankle disk or proprioceptive neuromuscular facilitation exercise regimens may also be helpful in preventing recurrent sprains
Prognostic Factors
- A higher physical workload, increased BMI, and greater body height may be associated with an increased risk of recurrent sprains and ankle instability
- Deficiencies in dynamic postural control, altered hip joint kinematics, and lack of mechanical stability/increased ligament laxity may also contribute to the development of chronic ankle instability (CAI)
- Physical therapy may be helpful in improving physical impairments after a sprained ankle and preventing progression to CAI 1
From the Research
Treatment Options for Sprained Ankle
- The traditional treatment for soft tissue injuries, including sprained ankles, consists of the RICE protocol: rest, ice, compression, and elevation, followed for up to 72 hours after a trauma 2.
- However, some studies suggest that the RICE protocol might not be the best way to promote healing due to limiting blood flow 2.
- Alternative treatments, such as hydrotherapy with super-saturated hydrogen-rich water, have shown promising results in reducing pain, swelling, and improving range of motion after an ankle sprain 2.
- Other treatment options include immobilization, protected mobilization, and primary surgical repair, with conservative treatment being the generally preferred approach 3.
- The principles of RICE (rest, ice, compression, elevation) are still widely recommended, with different treatment methodologies for grades I to III of sprain 4.
Comparison of Treatment Methods
- A study comparing early mobilization versus immobilization in the treatment of lateral ankle sprains found that early mobilization allows for earlier return to work and may be more comfortable for patients, with no significant differences in residual symptoms or ankle instability 5.
- Another study recommended a detailed examination and hands-on grading of ankle sprains to dictate treatment and forecast recovery time, with most ankle sprains being successfully treated nonsurgically with PRICE (protection, rest, ice, compression, and elevation) 6.
Treatment Recommendations
- For moderate and severe sprains, cast immobilization is often the preferred treatment, while basic care (e.g., ice and elevation) and rehabilitation are also important aspects of treatment 3.
- Clinicians should be prepared to diagnose, treat, and refer patients with ankle sprains appropriately, using techniques of inspection, palpation, and performing the anterior drawer and talar tilt tests to grade the sprain 4.