What is the treatment for ankle sprain versus soft tissue injury?

Treatment for Ankle Sprain vs Soft Tissue Injury

For ankle sprains and soft tissue injuries, first aid providers should implement the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) with cold application for 20-30 minutes and a compression wrap for comfort, while avoiding activities that cause pain and seeking medical attention. 1, 2

Initial Management

• A person with a painful extremity injury that limits use should avoid activities that cause pain and seek medical attention 1
• Cold application (ice and water surrounded by a damp cloth) should be applied to acute sprains or strains for pain and swelling, limited to 20-30 minutes per application without direct contact on skin to avoid cold injury 1
• Compression wraps may be applied after acute ankle sprains to promote comfort, ensuring circulation is not compromised 1
• The traditional RICE (Rest, Ice, Compression, Elevation) protocol has evolved to PRICE (Protection, Rest, Ice, Compression, Elevation) as the primary treatment approach 2, 3

Functional Treatment vs Immobilization

• Functional support, particularly bracing, is preferred over immobilization for ankle sprains 2
• Functional treatment allows patients to return to sports 4.6 days sooner than immobilization 2
• Patients undergoing functional treatment returned to work 7.1 days sooner than those treated with immobilization 2
• Lace-up or semirigid ankle supports are more effective than tape or elastic bandages 3

Rehabilitation Protocol

• Exercise therapy should begin within 48-72 hours after injury 3
• Supervised exercises focusing on proprioception, strength, coordination, and function have the strongest evidence (level 1) for effectiveness in ankle sprain rehabilitation 2
• Rehabilitation should include:
  • Range of motion exercises 3
  • Strengthening exercises 3
  • Proprioception training 3
• Manual mobilization is advised only in combination with other treatment modalities 2

Special Considerations for High Ankle Sprains

• High ankle sprains involve injury to the syndesmosis between the tibia and fibula 2
• These can be detected using the crossed-leg test, where pressure applied to the medial side of the knee produces pain in the syndesmosis area 2
• High ankle sprains typically require more intensive rehabilitation and longer recovery time 2

Common Pitfalls to Avoid

• Inadequate treatment can lead to chronic problems such as decreased range of motion, pain, and joint instability 2, 3
• Prolonged immobilization should be avoided as it shows no benefits compared to functional treatment 2, 3
• Heat application is not recommended for acute ankle injuries 3
• Excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation are common mistakes in management 4

Follow-up Care

• Re-examination 3-5 days after injury helps with accurate diagnosis and treatment planning 3
• Clinical assessment of ligament damage is optimized if delayed for 4-5 days post-injury when swelling has decreased 2
• For recurrent ankle sprains, exercise therapy should be incorporated into regular training activities 2

Differential Considerations

• Ankle sprains may involve more than just lateral collateral ligament injury 5
• Consider potential chondral or osteochondral lesions of the talus, anterior or posterior ankle impingement, subtalar joint injury, and tendon soft tissue injuries 5
• Multiple injuries often coexist and require comprehensive evaluation 5

Remember that while most ankle sprains respond well to conservative treatment, persistent pain and residual instability may require further evaluation and potentially surgical intervention in select cases 6.