What is the treatment plan for a sprain?

Treatment Plan for Sprains

The mainstay of treatment for sprains is rest and limiting use of the injured extremity, along with applying cold therapy (ice and water surrounded by a damp cloth) for 20-30 minutes, 3-4 times daily to reduce pain and swelling. 1

Initial Management

Immediate Care

• Avoid activities that cause pain and seek medical attention for painful extremity injuries that limit use 1
• Apply cold therapy (ice and water in a bag surrounded by a damp cloth) for 20-30 minutes, 3-4 times daily 1
  • Do not place ice directly on skin to prevent cold injury
  • Cold therapy has been shown to improve pain scores and reduce edema in the acute phase
• Consider compression wrap for ankle sprains to promote comfort 1
  • Ensure application doesn't compromise circulation
  • Note: Compression wraps have not been proven to reduce swelling, improve function, range of motion, or recovery time

Functional Treatment Approach

• Implement a functional approach consisting of 1:
  • 3-5 days of rest, ice, compression, and elevation
  • Early weight bearing as tolerated
  • Begin active exercises within 48-72 hours of injury

Rehabilitation Protocol

Early Phase (First Week)

• Begin progressive strengthening exercises within 48-72 hours 2:
  • Resistance band exercises
  • Heel raises
  • Balance and proprioception exercises

Support Devices

• Semirigid brace is recommended as the most cost-effective support option compared to taping 1
• Use of a brace combined with functional treatment speeds return to work 1
• Consider using crutches initially if weight-bearing causes significant pain 2

Pain Management

• NSAIDs can help reduce pain and inflammation, enabling faster return to activities 2
• Consider acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) as an alternative 2
• Topical diclofenac gel may provide localized pain relief with fewer systemic side effects 2

Return to Activity

Work Resumption

• A functional approach leads to the fastest resumption of work and daily activities compared to immobilization 1
• Using a brace with immediate functional treatment and a return-to-work schedule is advised 1

Sport Resumption

• Supervised exercises focusing on proprioception, strength, coordination, and function lead to faster return to sport 1
• Early functional treatment should address:
  • Proprioception
  • Muscle response time
  • Muscle strength
• Consider a semi-rigid ankle support for sports activities for at least 6 weeks to prevent recurrence 2

Common Pitfalls to Avoid

1. Inadequate cold application: Using ice alone is less effective than ice and water mixture 1
2. Direct ice contact with skin: Can cause cold injury 1
3. Overtightening compression wraps: Can compromise circulation 1
4. Prolonged immobilization: Functional treatment is superior to immobilization 1
5. Neglecting supervised rehabilitation: Supervised exercise provides better outcomes than non-supervised training 1
6. Premature return to full activity: Can lead to reinjury and chronic instability 2

By following this structured approach to sprain management, patients can achieve optimal recovery with reduced pain, improved function, and faster return to normal activities.