Initial Treatment for a Suspected Sprain
For a suspected sprain, immediate treatment should include functional support (such as a brace or compression wrap), limited rest, application of ice for 20-30 minutes several times daily, and pain control with NSAIDs, followed by early mobilization and progressive exercise therapy. 1
Immediate Management (First 24-72 Hours)
Pain and Swelling Control
- Ice application: Apply cold therapy (ice wrapped in a damp cloth) to the injured area for 20-30 minutes, 3-4 times daily 1
- Do not place ice directly on skin to prevent cold injury
- Continue for up to 72 hours after injury
- Compression: Apply a compression wrap to provide comfort and support 1
- Ensure it's not too tight to avoid compromising circulation
- Elastic bandages alone are less effective than semirigid supports
- Elevation: Keep the injured limb elevated above heart level when possible 1
- Pain medication: NSAIDs (e.g., naproxen) are effective for pain control and reducing inflammation 1, 2
- Standard dosing: 500mg initially, followed by 250mg every 6-8 hours as needed
- Do not exceed 1250mg on first day and 1000mg on subsequent days
Activity Modification
- Limited rest: Avoid activities that cause pain for the first 24-72 hours 1
- Functional treatment: Maintain some movement rather than complete immobilization 1
- Weight bearing: Limit weight bearing as tolerated, using assistive devices if necessary 1
Follow-up Treatment (After 72 Hours)
Functional Support
- External support: Use a brace or functional support for 4-6 weeks 1
- Semirigid supports are superior to elastic bandages
- Provides protection against re-injury
Progressive Rehabilitation
- Early mobilization: Begin gentle range-of-motion exercises within 48-72 hours as pain allows 1
- Strengthening exercises: Start with isometric exercises and progress to resistance training 1
- Proprioceptive training: Include balance exercises to improve joint stability 1
- Gradual return to activity: Increase activity levels progressively based on pain and function 1
Important Considerations
When to Seek Medical Attention
- Inability to bear weight on the affected limb
- Severe pain or swelling
- Visible deformity or joint instability
- No improvement after 3-5 days of home treatment
- Suspected fracture (based on Ottawa Ankle Rules if ankle sprain) 1
Common Pitfalls to Avoid
- Complete immobilization: Functional treatment with early mobilization leads to faster recovery than immobilization 1
- Relying solely on RICE: While components of RICE (Rest, Ice, Compression, Elevation) are helpful, the complete protocol alone has limited evidence for effectiveness 1
- Returning to activity too soon: Premature return to full activity increases risk of re-injury 1
- Neglecting rehabilitation: Proper rehabilitation reduces the risk of chronic instability and recurrent sprains 1
Evidence Quality Considerations
The most recent evidence from the British Journal of Sports Medicine (2018) indicates that while ice and compression may provide symptomatic relief, they have not been proven to significantly affect long-term outcomes 1. However, they remain recommended in clinical practice guidelines for initial pain and swelling management 1. Functional treatment with early mobilization has stronger evidence for improving outcomes compared to immobilization 1.