Sprain Management
The recommended management for a sprain is functional treatment with early exercise therapy and functional support (particularly bracing), as this approach leads to faster recovery and return to normal activities. 1
Initial Management
- A person with a painful extremity injury that limits use should avoid activities that cause pain and seek medical attention 1
- Exercise therapy should be started as soon as possible to recover joint functionality 1
- Functional support (preferably a brace) is recommended over immobilization 1
- NSAIDs may be used to reduce pain and swelling in the acute phase 1
- Cold therapy (ice) can be applied for pain and swelling, limited to 20-30 minutes per application without direct contact on the skin 1
- RICE (Rest, Ice, Compression, Elevation) alone is not recommended as a treatment modality for sprains 1
Functional Support Options
- Braces are preferred over other types of functional support for optimal outcomes 1
- Lace-up or semirigid ankle supports are more effective than tape or elastic bandages 2
- A compression wrap may be considered after an acute sprain to promote comfort, but should be applied without compromising circulation 1
Exercise Therapy Protocol
- Functional rehabilitation should begin within 48-72 hours after injury 2
- Supervised exercises focusing on proprioception, strength, coordination, and function are strongly recommended 1
- For recurrent sprains, exercise therapy should be incorporated into regular training activities 1
Return to Activity
- Functional treatment allows patients to return to sports approximately 4.6 days sooner than immobilization 3
- Patients using functional treatment return to work approximately 7.1 days sooner than those treated with immobilization 3
- A functional approach with early weight-bearing leads to the fastest resumption of work and daily activities 1
Follow-up Care
- Re-examination 3-5 days after injury helps with accurate diagnosis and treatment planning 2
- Late physical examination (4-5 days post-injury) is advised to come to conclusions on the severity of the ligament damage when swelling has decreased 1
Common Pitfalls to Avoid
- Complete immobilization should be avoided as it shows no benefits compared to functional treatment 1
- Prolonged rest delays recovery and is not recommended 1
- Heat application should be avoided in the acute phase of injury 3
- Delaying the initiation of exercise therapy should be avoided, as early movement promotes better healing 1
- Inadequate treatment can lead to chronic problems such as decreased range of motion, pain, and joint instability 3
Special Considerations
- For pregnant patients with ankle sprains, lace-up or semirigid ankle supports are recommended over tape or elastic bandages 2
- Manual mobilization is only advised in combination with other treatment modalities to enhance the treatment effect 1
- Surgery is only advised for patients that require quick recovery (such as professional athletes) or whose complaints are not resolved by conservative treatment 1