Treatment of Ankle Ligament Sprains
Functional treatment is the recommended approach for ankle ligament sprains, consisting of 3-5 days of rest, ice, compression, and elevation (RICE) with early weight-bearing, followed by active exercise. 1
Initial Management (First 72 Hours)
Apply the PRICE protocol:
- Protection: Limit weight-bearing for up to 72 hours
- Rest: Essential to reduce further injury and promote healing
- Ice: Apply cryotherapy for 15-20 minutes every 2-3 hours
- Compression: Use a compressive device to reduce swelling
- Elevation: Keep the ankle elevated above heart level 2
Pain management:
- NSAIDs (e.g., naproxen, diclofenac) or paracetamol (acetaminophen) for short-term pain relief 2
Support and Protection
- Semi-rigid ankle brace is the most cost-effective support option compared to taping 1
- Continue using support for 4-6 weeks, especially in individuals with recurrent sprains 2
- Avoid complete immobilization as it delays recovery 2
Rehabilitation Program
Early Phase (Days 3-7)
- Begin gentle range of motion exercises within 48-72 hours
- Start early weight-bearing as tolerated
- Manual joint mobilization to increase ankle dorsiflexion 2
Intermediate Phase (Weeks 1-3)
- Progressive weight-bearing exercises
- Proprioceptive and neuromuscular training
- Strengthening exercises for ankle and lower extremity 2
Advanced Phase (Weeks 4-6+)
- Balance and coordination training
- Sport-specific exercises
- Continued proprioception training using ankle disk exercises 2
Return to Activity
- Patients with functional treatment return to sports 4.6 days earlier and to work 7.1 days earlier than those with immobilization 2
- Criteria for return to activity:
- Pain-free walking
- Full range of motion
- Restored strength
- Ability to perform sport-specific movements 2
Prevention of Recurrent Sprains
- Exercise therapy reduces the risk of recurrent injury (RR 0.37) when continued for 4-6 weeks 2
- Ankle braces have been proven more effective than taping and neuromuscular training for prevention 1
- Proprioceptive exercises should be incorporated into regular training routines 2
Common Pitfalls to Avoid
- Excessive imaging: Use Ottawa Ankle Rules to determine need for X-rays
- Unwarranted non-weight-bearing: Early controlled weight-bearing improves outcomes
- Unjustified immobilization: Functional treatment is superior to immobilization
- Inadequate rehabilitation: Complete rehabilitation program is essential to prevent chronic instability 3
- Delayed functional movements: Begin active exercises early to prevent adhesions 4
Special Considerations
- Surgery should be reserved for patients with lateral ligament ruptures who fail conservative treatment 1
- Re-examination 3-5 days after injury helps distinguish partial tears from complete ligament ruptures 2
- 20% of acute ankle sprains may develop mechanical or functional instability despite appropriate treatment 5