What is the recommended follow-up care for a patient recovering from a mild to moderate ankle sprain?

Follow-Up Care for Mild to Moderate Ankle Sprains

For patients recovering from mild to moderate ankle sprains, early functional rehabilitation with progressive exercises focusing on proprioception, strength, coordination, and function is strongly recommended as it leads to faster recovery and return to normal activities. 1

Initial Treatment Phase (0-72 hours)

• Apply RICE protocol:

  • Rest: Limit weight-bearing as needed for comfort
  • Ice: Apply cold therapy for 20-30 minutes, 3-4 times daily with a damp cloth to prevent cold injury 1
  • Compression: Use a semi-rigid brace (most cost-effective option compared to taping) 1
  • Elevation: Keep the ankle elevated when possible

• Pain management:

  • NSAIDs (e.g., naproxen, diclofenac) for pain and inflammation control
  • Consider acetaminophen (1000mg every 6 hours, max 4000mg daily) as an alternative 1
  • Topical diclofenac gel for localized pain relief with fewer systemic side effects 1

Early Rehabilitation Phase (48-72 hours to 2 weeks)

• Begin early functional treatment within 48-72 hours of injury 1
• Initiate progressive weight-bearing as tolerated 1
• Start active range of motion exercises
• Introduce gentle strengthening exercises:
  • Resistance band exercises
  • Heel raises
  • Balance and proprioception exercises 1

Intermediate Rehabilitation Phase (2-6 weeks)

• Progress to more challenging exercises:

  • Single-leg balance activities
  • Proprioceptive training on unstable surfaces
  • Sport-specific movements as appropriate

• Continue using a semi-rigid ankle support for sports activities for at least 6 weeks to prevent recurrence 1

• Return to work guidelines based on injury severity 2:

  Time from injury	Degree of injury	Work restrictions
  2 weeks	Distortion	Mostly sitting work, limit lifting to <10kg
  3-4 weeks	Distortion	Return to full work depending on requirements
  3-6 weeks	Partial/total ligament rupture	Mostly sitting work, limit lifting to <10kg
  6-8 weeks	Partial/total ligament rupture	Return to full work depending on requirements

Advanced Rehabilitation Phase (6+ weeks)

• Continue proprioceptive exercises as they significantly reduce the risk of recurrent sprains (RR 0.62,95% CI 0.51 to 0.76) 2
• Incorporate sport-specific training for athletes
• Consider ongoing use of ankle support during high-risk activities

When to Consider Additional Interventions

• If no improvement after 4-6 weeks of conservative management:

  • Reassess for possible complications or misdiagnosis
  • Consider imaging (MRI) for suspected high-grade ligament injuries 1
  • Consider referral to sports medicine specialist or orthopedic surgeon

• Consider surgical options if conservative treatment fails after 4-6 months 1

Common Pitfalls to Avoid

1. Prolonged immobilization: This delays recovery and can lead to stiffness and muscle atrophy. Early functional treatment is superior to immobilization 2, 1

2. Inadequate rehabilitation: Up to 40% of individuals develop chronic ankle instability after a sprain, often due to insufficient rehabilitation 2

3. Ignoring proprioceptive training: This is crucial for preventing recurrent sprains and should be incorporated into the rehabilitation program 2, 1

4. Returning to full activity too soon: This increases the risk of re-injury. Follow the recommended timeline for return to work and sports 2

5. Overlooking psychological factors: Fear of re-injury can impede recovery and should be addressed during rehabilitation 1