What is the best approach for recovery from an ankle sprain?

Best Approach for Recovery from Ankle Sprain

Functional treatment with early exercise therapy should be the primary approach for ankle sprain recovery, as it leads to faster return to normal activities and better outcomes compared to immobilization or RICE protocol alone. 1

Initial Assessment and Management

Diagnostic Approach

• Apply Ottawa Ankle and Foot Rules to rule out fracture (highly sensitive, correctly rules out fracture in 299 out of 300 patients) 1
• Delayed physical examination (4-5 days post-injury) provides the most accurate assessment of ligament damage with 84% sensitivity and 96% specificity 1
• Key findings for severe (grade III) sprains: swelling, hematoma, pain on palpation, and positive anterior drawer test 1

Immediate Management (First 24-72 Hours)

1. Pain Management

   • NSAIDs (oral or topical) are effective for reducing pain and swelling without significant risk of adverse events 1
   • Options include piroxicam, celecoxib, naproxen, or diclofenac 1

2. Functional Support

   • Apply a brace (preferred) or ankle tape for support 1
   • Lace-up or semi-rigid supports are more effective than elastic bandages or tape 1

3. Early Mobilization

   • Begin functional treatment with controlled movement within 48-72 hours of injury 1
   • Avoid complete immobilization as it shows no benefits and delays recovery 1

Important: Current evidence does not support the traditional RICE protocol (Rest, Ice, Compression, Elevation) as a standalone treatment 1. While previously recommended, recent guidelines indicate that RICE alone has no positive influence on pain, swelling, or function.

Rehabilitation Protocol

Phase 1 (Days 1-3)

• Limited weight-bearing as tolerated with appropriate support
• Begin gentle range of motion exercises
• NSAIDs for pain and swelling control

Phase 2 (Days 4-14)

• Progressive exercises to restore motion and strength 1
• Include:
  • Ankle circles
  • Toe curls and toe spreading
  • Towel stretches for dorsiflexion
  • Heel and toe raises
  • Resistance band exercises in all directions

Phase 3 (Week 2 onward)

• Progress to endurance training, sport-specific drills, and balance training 1
• Focus on proprioception, strength, coordination, and function 1
• Supervised exercises show better outcomes than home exercises alone 2

Evidence for Accelerated Rehabilitation

An accelerated exercise protocol during the first week after ankle sprain has been shown to improve ankle function significantly compared to standard care 3. Patients following accelerated rehabilitation demonstrated:

• Higher activity levels (more time walking, higher step counts)
• Better functional scores at weeks 1 and 2 post-injury
• No increase in reinjury rates (4% in both groups)

Adjunctive Therapies

• Manual therapy: When combined with supervised exercise, leads to better recovery outcomes than exercise alone 2
• Acupressure therapy: May improve recovery time and quality of life measures following acute ankle sprains 4

Return to Work/Sport Guidelines

• Immediate functional treatment with a return-to-work schedule minimizes work absenteeism 1
• For sport resumption, supervised exercises focusing on proprioception, strength, coordination, and function are recommended 1
• Functional support (brace or tape) should be used during initial return to sport activities

Common Pitfalls to Avoid

1. Prolonged immobilization: Delays recovery and leads to longer time away from work/sport
2. Relying solely on RICE protocol: Current evidence does not support this as an effective standalone treatment
3. Inadequate rehabilitation: Failing to progress through all phases of rehabilitation increases risk of recurrent sprains
4. Premature return to full activity: Can lead to reinjury; functional testing should guide return decisions
5. Neglecting proprioceptive training: Essential for preventing recurrent sprains (70-80% of people who sprain their ankles will have continued problems or resprain) 2

By following this evidence-based approach with emphasis on early functional treatment and progressive rehabilitation, patients can expect optimal recovery from ankle sprains with reduced risk of chronic instability or reinjury.