What is the recommended treatment for a sprain?

Treatment for Sprain

The recommended treatment for a sprain is the PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) followed by early functional rehabilitation with supervised exercises and appropriate ankle support. 1

Initial Management (First 72 Hours)

PRICE Protocol

1. Protection: Protect the injured area from further injury
2. Rest: Limit weight-bearing for up to 72 hours to allow ligaments to heal 1
3. Ice: Apply cryotherapy to reduce swelling and pain
   • Apply ice directly to the injured area for 15-20 minutes
   • Repeat every 2-3 hours during waking hours
   • Continue for the first 24-72 hours after injury 1
4. Compression: Use a compressive device or bandage
   • Semirigid or lace-up supports are superior to elastic bandages 1
5. Elevation: Keep the injured limb elevated above heart level when possible

Pain Management

• NSAIDs (e.g., naproxen, ibuprofen) are recommended to:
  • Reduce pain and swelling
  • Improve function
  • Speed return to normal activities 1
• Controlled trials show NSAIDs improve pain control, decrease swelling, and allow more rapid return to activity compared to placebo 1

Functional Rehabilitation (After 48-72 Hours)

Phase 1 (Days 3-7)

• Begin exercises to restore motion and strength 1
• Focus on:
  • Range of motion exercises
  • Gentle strengthening
  • Weight-bearing as tolerated

Phase 2 (Week 1-3)

• Progress to:
  • Proprioception exercises
  • Balance training
  • Coordination drills
  • Functional activities

Phase 3 (Week 3+)

• Advance to:
  • Sport-specific training
  • Endurance exercises
  • Full functional activities

Support Devices

• Semirigid braces or lace-up supports are recommended over elastic bandages or tape 1
• Benefits of semirigid supports:
  • Shorter time to return to sports and work 1
  • Less ankle instability 1
  • More cost-effective than taping 1

Supervised vs. Non-supervised Rehabilitation

• Supervised exercise programs lead to faster return to sport and better outcomes than non-supervised training 1
• Supervised exercises should focus on:
  • Proprioception
  • Strength
  • Coordination
  • Functional activities 1

Prevention of Recurrence

• For patients with history of ankle sprains:
  • Continue using semirigid or lace-up ankle supports during high-risk activities 1
  • Implement proprioceptive training (ankle disk exercises) 1
  • Neuromuscular training has proven clinical benefits beyond prevention alone 1

Common Pitfalls to Avoid

1. Avoiding immobilization: Functional treatment is superior to immobilization, with patients returning to work 7.1 days sooner and to sports 4.6 days sooner 1

2. Not using appropriate support: Elastic bandages are inferior to semirigid or lace-up supports 1

3. Applying heat: Heat is not recommended for acute ankle injuries 1

4. Inadequate rehabilitation: Failure to properly rehabilitate can lead to chronic problems including decreased range of motion, pain, and joint instability 1

5. Neglecting prevention strategies: Especially important for those with history of recurrent sprains 1

By following this evidence-based approach to sprain management, patients can expect optimal recovery with reduced risk of chronic problems and recurrence.