Treatment Options for Different Grades of Sprains
Functional treatment with early exercise therapy and functional support is the most effective approach for all grades of sprains, leading to faster recovery and return to normal activities compared to immobilization.1
Classification of Sprain Grades
- Grade I (Mild): Minimal stretching or microscopic tearing of ligament fibers with minimal tenderness, swelling, and no joint instability 1
- Grade II (Moderate): Partial tearing of ligament fibers with moderate pain, swelling, and some joint instability 1
- Grade III (Severe): Complete ligament tear with significant swelling, pain, and joint instability 1
Initial Management for All Grades
PRICE Protocol
- While traditionally recommended, the PRICE (Protection, Rest, Ice, Compression, Elevation) protocol alone has not been proven to positively influence pain, swelling, or function 1, 2
- Individual components may still be useful when combined with active treatment approaches 2
- Ice application for 15-20 minutes several times daily for the first 48-72 hours can help reduce swelling when used alongside exercise therapy 2
Pain Management
- NSAIDs are effective for reducing pain and swelling in the acute phase 1
- Diclofenac shows superior results for pain reduction during the first 48 hours compared to ibuprofen 2
- Paracetamol appears equally effective as NSAIDs with potentially fewer side effects 2
Treatment by Sprain Grade
Grade I (Mild) Sprains
- Functional support with an ankle brace or tape for 1-3 weeks 1, 2
- Early weight-bearing as tolerated 1
- Begin gentle range of motion exercises within 24-48 hours 2
- Return to normal activities typically within 1-2 weeks 2
Grade II (Moderate) Sprains
- Functional support with a semirigid brace for 4-6 weeks 1, 2
- Progressive weight-bearing as tolerated, starting within 3-5 days 1
- Supervised exercise therapy focusing on proprioception, strength, and coordination 1
- Return to normal activities typically within 2-6 weeks 1
Grade III (Severe) Sprains
- Functional support with a semirigid brace for 6-8 weeks 1
- May require a short period (3-5 days) of immobilization for pain control 1
- Progressive rehabilitation with supervised exercises 1
- Consider surgical consultation for certain cases with complete ligament tears, especially in athletes 1
- Return to normal activities typically within 6-12 weeks 1
Rehabilitation Protocol for All Grades
Phase 1: Acute Phase (1-7 days)
- Control pain and swelling with NSAIDs and intermittent ice application 1, 2
- Begin early range of motion exercises as pain allows 1
- Use appropriate functional support (brace or tape) 1
- Begin weight-bearing as tolerated 1
Phase 2: Subacute Phase (1-3 weeks)
- Progress to strengthening exercises 1
- Include proprioceptive training on stable and unstable surfaces 1
- Continue with functional support during activities 1
Phase 3: Functional Phase (2-6 weeks)
- Sport-specific or activity-specific exercises 1
- Progressive return to normal activities 1
- Continue proprioceptive training to prevent recurrence 1
Prevention of Recurrence
- Semirigid or lace-up ankle supports are recommended to decrease the risk of recurrent injury, especially in patients with a history of sprains 1
- Graded exercise regimens involving proprioceptive elements such as ankle disk training reduce the risk of recurrent sprains 1
- Supervised exercises show better outcomes compared to non-supervised training 1
Common Pitfalls to Avoid
- Complete immobilization leads to muscle atrophy, joint stiffness, and delayed recovery 1, 2
- Premature return to full activity increases risk of re-injury and chronic instability 2
- Relying solely on passive treatments is ineffective; active rehabilitation with progressive exercises is essential 2
- Ignoring persistent symptoms beyond 4-6 weeks may indicate incomplete healing requiring specialized care 2