Recommended Dose of Diclofenac Gel for Sprains
For treating a sprain, diclofenac 1% gel should be applied to the affected area twice daily, with the application spread evenly around the injured area. 1, 2
Diclofenac Gel Dosing Guidelines
- Diclofenac 1% gel is the recommended topical NSAID formulation for treating sprains, with application twice daily to the affected area 1, 3
- For knee sprains specifically, apply 2 pump actuations (40 mg diclofenac) directly to the affected knee twice daily 2
- For ankle sprains, diclofenac diethylamine 2.32% gel applied twice daily has shown significant efficacy in reducing pain and swelling 3
- Apply to clean, dry skin and spread evenly around the injured area 2
Evidence for Efficacy
- Topical diclofenac has been shown to be superior to placebo and equivalent to oral diclofenac for reducing pain associated with musculoskeletal injuries 1
- In acute musculoskeletal pain (strains and sprains), diclofenac gel formulations demonstrate good efficacy with a Number Needed to Treat (NNT) of 1.8-4.7, indicating strong pain relief 4, 5
- By day 5 of treatment, diclofenac gel can reduce pain on movement by approximately 49% compared to 25% with placebo 3
- Diclofenac gel typically causes less intense local skin reactions than other topical pain treatments 1
Treatment Duration
- For acute sprains, continue application for 7-10 days for optimal results 3, 5
- Some guidelines suggest treatment for up to 60-90 days for persistent pain, though this is typically for chronic conditions rather than acute sprains 1
Application Instructions
- Wash hands before and after application 2
- Wait until the treated area is completely dry before covering with clothing 2
- Avoid showering/bathing for at least 30 minutes after application 2
- Do not apply to open wounds or broken skin 2
- Avoid skin-to-skin contact between other people and the treated area until completely dry 2
Capsaicin Alternative
- If diclofenac is not available or tolerated, capsaicin cream (0.025% to 0.075%) can be applied to affected areas 3-4 times daily 1
- Note that capsaicin may cause initial stinging and burning sensations 1
- Capsaicin may need to be used continuously for 2-4 weeks before achieving full therapeutic effect 1
Safety Considerations
- Topical NSAIDs like diclofenac have significantly fewer gastrointestinal adverse events compared to oral NSAIDs 1
- Local adverse events (skin irritation) may occur but are generally mild and transient 4, 5
- Avoid combining topical diclofenac with oral NSAIDs unless the benefit outweighs the risk 2
- Use the lowest effective dosage for the shortest duration to minimize potential side effects 2
Additional Management Recommendations
- Consider combining topical diclofenac with functional support (brace) for 4-6 weeks for optimal recovery from sprains 1
- Exercise therapy is an important component of sprain management and should be initiated early 1
- RICE (Rest, Ice, Compression, Elevation) alone has not shown significant benefit, but ice may be helpful when combined with other treatments 1