How do I treat an ankle strain?

Treatment of Ankle Strain

For an ankle strain, you should follow the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) for the first 48-72 hours, then begin functional rehabilitation with progressive exercises while avoiding activities that cause pain. 1

Immediate Management (First 48-72 Hours)

1. Rest and Protection:

   • Avoid activities that cause pain 1
   • Limit use of the injured extremity to prevent worsening the injury 1
   • Seek medical attention if pain limits normal use 1

2. Ice Application:

   • Apply cold therapy (ice and water in a bag surrounded by a damp cloth) to reduce pain and swelling 1
   • Apply for 20-30 minutes, 3-4 times daily 1
   • Do not place ice directly on skin to prevent cold injury 1

3. Compression:

   • Consider applying a compression wrap to promote comfort 1
   • Ensure the wrap is not too tight to avoid compromising circulation 1
   • Note that while compression may provide comfort, evidence shows limited effect on reducing swelling or improving recovery time 1, 2

4. Elevation:

   • Keep the injured ankle elevated to help reduce swelling 1

5. Pain Management:

   • NSAIDs (e.g., ibuprofen, naproxen) can be used for pain control and to reduce swelling 1
   • NSAIDs have been shown to improve pain control, decrease swelling, and allow for more rapid return to activity 1

Functional Rehabilitation (After 48-72 Hours)

1. Begin Exercise Therapy:

   • Start exercise therapy as soon as pain allows to restore joint function 1
   • Focus on:
     • Range of motion exercises
     • Progressive strengthening exercises
     • Proprioceptive training 1, 3

2. Functional Support:

   • Functional treatment is superior to immobilization 1
   • A brace is preferred over other forms of support 1
   • Patients using functional treatment return to work and sports activities significantly faster than those with immobilization 1

3. Progressive Exercise Program:

   • Begin with gentle range-of-motion exercises
   • Progress to isometric and then isotonic strength training
   • Add balance and proprioception exercises as pain allows 3, 4
   • Gradually increase intensity by no more than 10% per week 3

Return to Activity

1. Gradual Progression:

   • Start with low-impact activities (swimming, cycling) before progressing to higher-impact activities 3
   • Follow a walk/run interval training program when returning to running 3
   • Return to full activity only when:
     • Full range of motion is restored
     • Strength is comparable to the uninjured side
     • Balance and proprioception are adequate 4

2. Prevention of Recurrence:

   • Consider continued use of ankle support during high-risk activities, especially for those with history of recurrent sprains 1
   • Maintain a home exercise program focusing on strength and proprioception 3, 5

When to Seek Further Medical Attention

• If pain severely limits use of the ankle 1
• If pain does not improve after 2-3 weeks of conservative treatment 3
• If you experience night pain or pain at rest 3
• If you suspect a fracture (unable to bear weight, significant swelling, or deformity) 1

Common Pitfalls to Avoid

• Returning to full activity too soon, which may lead to re-injury
• Relying solely on passive treatments without active rehabilitation
• Prolonged immobilization, which can lead to stiffness and muscle weakness 1
• Ignoring proprioceptive training, which is crucial for preventing recurrent injuries 4

Remember that while most ankle strains improve with conservative management, proper rehabilitation is essential to prevent chronic instability and recurrent injuries.