What is the recommended treatment for a knee sprain?

Treatment of Knee Sprain

Functional treatment with early exercise therapy and functional support (brace or tape) is the recommended approach for knee sprain treatment, rather than immobilization, as it leads to faster recovery and return to normal activities. 1

Initial Management

• Functional treatment should be initiated as soon as possible after injury and consists of three phases 1:

  1. Protection of the injured area while allowing for some movement
  2. Exercise therapy to restore motion and strength (beginning within 48-72 hours)
  3. Endurance training and sport-specific drills when phase 2 is well underway

• NSAIDs may be used to reduce pain and swelling in the acute phase 1

• The traditional RICE (Rest, Ice, Compression, Elevation) protocol is no longer recommended as a standalone treatment as there is no evidence that it positively influences pain, swelling, or patient function 1

Evidence on Individual Components

Functional Support

• A brace is the preferred functional support option for knee sprains, providing better outcomes than immobilization 1

• Functional support should be used for 4-6 weeks to promote healing while maintaining joint mobility 1

• Lace-up or semirigid supports are more effective than tape or elastic bandages for supporting injured joints 1

Exercise Therapy

• Exercise therapy should be started as soon as possible to recover joint functionality 1

• Supervised exercises focusing on proprioception, strength, coordination, and function are recommended for optimal recovery 1

• Exercise therapy has been shown to be effective for preventing recurrent sprains and should be incorporated into regular training activities 1

Pain Management

• NSAIDs (such as ibuprofen, naproxen, or diclofenac) have been shown to reduce pain in the short term (<14 days) without significantly increasing adverse events compared to placebo 1

• Paracetamol (acetaminophen) appears to be equally effective as NSAIDs for pain management with potentially fewer side effects 1

• Note that NSAIDs may potentially delay natural healing as they suppress inflammation, which is a necessary component of tissue recovery 1

Cryotherapy (Ice)

• While traditionally recommended, cryotherapy alone has limited evidence supporting its effectiveness 1

• If used, cryotherapy appears most beneficial when combined with exercise therapy rather than as a standalone treatment 1

• Some evidence suggests that intermittent ice application protocols may be more effective at reducing pain than standard continuous application 2

Return to Activity

• Functional treatment allows patients to return to sports approximately 4.6 days sooner than immobilization 1

• Patients using functional treatment return to work approximately 7.1 days sooner than those treated with immobilization 1

• A functional approach with early weight-bearing leads to the fastest resumption of work and daily activities compared with other treatment methods 1

Common Pitfalls to Avoid

• Avoid complete immobilization of the knee as it shows no benefits and delays recovery 1

• Do not rely solely on RICE protocol as there is insufficient evidence for its effectiveness as a standalone treatment 1

• Avoid heat application in the acute phase of injury 1

• Do not delay the initiation of exercise therapy, as early movement promotes better healing and functional outcomes 1