What is the best way to treat a sprain?

Best Treatment for Sprains

The best treatment for a sprain is the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) for the first 24-72 hours, followed by functional rehabilitation with early mobilization rather than immobilization, supplemented with NSAIDs for pain control and a semi-rigid support for stability. 1

Initial Management (First 24-72 Hours)

The PRICE protocol is recommended as the first-line treatment for acute sprains:

• Protection: Protect the injured area from further injury using appropriate support
• Rest: Limit weight-bearing for up to 72 hours to allow ligaments to heal
• Ice: Apply cryotherapy to reduce edema and decrease pain
• Compression: Use a compressive device to limit swelling
• Elevation: Keep the injured area elevated to reduce swelling

Cryotherapy (Ice Application)

• Apply ice directly to reduce edema and decrease pain and recovery time 1
• Use for 15-20 minutes every 2-3 hours during the first 24-48 hours
• Do not apply heat during the acute phase as it may increase swelling 1

Compression

• Use a compressive device to protect the ankle and limit swelling
• Lace-up or semi-rigid supports are more effective than elastic bandages or tape 1

Medication Management

NSAIDs

• NSAIDs (e.g., naproxen, ibuprofen, diclofenac) are effective for reducing pain, decreasing swelling, and improving function 1
• Start NSAIDs early to control inflammation and pain
• A randomized controlled trial of 364 participants showed those taking NSAIDs experienced less pain, increased exercise endurance, and quicker return to activity 1

Rehabilitation Phase (After 48-72 Hours)

Functional Treatment vs. Immobilization

• Functional treatment is superior to immobilization for ankle sprains 1
• Patients with functional treatment returned to sports 4.6 days sooner and to work 7.1 days sooner than those with immobilization 1

Three-Phase Functional Rehabilitation:

1. Initial Phase (0-72 hours): PRICE protocol to minimize pain and swelling
2. Intermediate Phase (48-72 hours post-injury): Begin exercises to restore motion and strength
   • Range of motion exercises
   • Progressive weight-bearing as tolerated
   • Strengthening exercises
3. Advanced Phase: Begin when phase 2 is well underway
   • Endurance training
   • Sport-specific drills
   • Balance and proprioception training

Support Devices

• Semi-rigid or lace-up supports are recommended over elastic bandages 1
• These supports result in:
  • Shorter time to return to sports and work
  • Less ankle instability
  • Better protection against future sprains

Common Pitfalls to Avoid

1. Prolonged immobilization: This can lead to joint stiffness, muscle atrophy, and delayed recovery 1
2. Applying heat in the acute phase: Heat can increase swelling and inflammation 1
3. Returning to full activity too soon: This increases risk of re-injury
4. Using only elastic bandages: These are less effective than semi-rigid supports 1, 2
5. Neglecting rehabilitation exercises: These are crucial for restoring function and preventing recurrence

Special Considerations

• For severe sprains (Grade III), some evidence suggests surgical repair may result in less residual pain and fewer recurrent sprains, but this remains controversial 1
• Compression therapy alone has inconclusive evidence for effectiveness 1, 2
• RICE alone without progression to functional rehabilitation is not recommended 1

By following this evidence-based approach, most sprains will heal well with excellent long-term outcomes and minimal complications 3.