Treatment of Lateral Ankle Sprain with Mild to Moderate Swelling
For a lateral ankle sprain with mild to moderate swelling, functional support with an ankle brace for 4-6 weeks is the most effective treatment approach, combined with early exercise therapy and short-term NSAIDs for pain management. 1
Initial Management
- RICE (Rest, Ice, Compression, Elevation): There is no evidence that RICE alone has any positive influence on pain, swelling, or patient function. Individual components like isolated cryotherapy or compression therapy alone are not effective 1
- Ice application: When used in combination with exercise therapy, ice can help reduce swelling. Apply for 15-20 minutes at a time, several times daily for the first 48-72 hours 1
- Ethyl chloride spray: Not recommended as there is no evidence supporting its effectiveness in ankle sprain management 1
- Elevation: While specific evidence on elevation alone is lacking, elevating the injured ankle above heart level when resting may help reduce swelling, especially in the first 48-72 hours 1
Medication
- NSAIDs: Oral or topical NSAIDs are effective for reducing pain in the short term (<14 days) 1
- Ibuprofen can be used at standard dosages (e.g., 400-600mg three times daily)
- Diclofenac has shown superior results for pain reduction during the first 48 hours compared to ibuprofen 1
- Paracetamol (Acetaminophen): Equally effective as NSAIDs for pain relief, swelling reduction, and range of motion improvement, with potentially fewer side effects (500mg three times daily) 1, 2
- Caution: NSAIDs may delay the natural healing process as the inflammation they suppress is a necessary component of tissue recovery 1
Functional Support
- Ankle brace: Use of an ankle brace for 4-6 weeks shows the greatest effects compared to other types of functional support 1
- Compression: If used, apply compression bandage during the day for the first 7-10 days, but not continuously for 24 hours 1, 3
- Avoid immobilization: Complete immobilization with a cast is not recommended as it leads to less optimal outcomes 1
Exercise Therapy
- Early mobilization: Begin gentle range of motion exercises as soon as pain allows, typically within 24-48 hours 1
- Progressive exercises: Start with non-weight bearing ankle movements, then progress to weight-bearing exercises as tolerated 1
- Proprioceptive training: Include balance exercises on stable and then unstable surfaces once weight-bearing is comfortable 1
- Strengthening: Focus on peroneal muscle strengthening to improve lateral ankle stability 1
Recovery Timeline for Mild Sprain
- First 24-72 hours: Focus on pain and swelling management with relative rest, ice, and elevation 1, 3
- Days 3-7: Begin gentle range of motion exercises and progressive weight-bearing as tolerated 1
- Days 7-14: Continue with strengthening exercises and proprioceptive training 1
- Days 14-21: Most patients with mild sprains can return to normal activities 1, 3
- Weeks 4-6: Continue wearing functional support during high-risk activities to prevent recurrence 1
Follow-up Care
- Monitor for complications: Persistent pain, instability, or swelling beyond 4-6 weeks may indicate incomplete healing or additional injury requiring further evaluation 1
- Return to sport: For athletes, supervised exercises focusing on proprioception, strength, coordination, and function should be completed before returning to sport 1
Common Pitfalls to Avoid
- Prolonged immobilization: Leads to muscle atrophy, joint stiffness, and delayed recovery 1
- Premature return to full activity: Can lead to re-injury and chronic instability 1
- Relying solely on passive treatments: Active rehabilitation with progressive exercises is essential for optimal recovery 1
- Ignoring persistent symptoms: Chronic pain or instability may indicate more severe injury requiring specialized care 1