What is the treatment for a 15-year-old, 200-pound male with an ankle sprain?

Treatment for a 15-Year-Old Male with Ankle Sprain

The optimal treatment for a 15-year-old, 200-pound male with an ankle sprain should include functional treatment with PRICE protocol (Protection, Rest, Ice, Compression, Elevation), early exercise therapy, and appropriate functional support. 1, 2

Initial Management

• The patient should avoid activities that cause pain and seek medical attention for proper evaluation of the ankle sprain 1
• Apply cold therapy (ice and water surrounded by a damp cloth) to the injured ankle for 20-30 minutes, 3-4 times daily, without direct contact on skin to avoid cold injury 1, 2
• A compression wrap may be applied to promote comfort, ensuring it doesn't compromise circulation 1
• Elevation of the injured ankle helps reduce swelling 2
• NSAIDs may be used to reduce pain and swelling in the acute phase 1

Functional Treatment vs. Immobilization

• Functional treatment is strongly preferred over immobilization, as patients return to sports 4.6 days sooner and to work 7.1 days sooner with functional treatment 1
• A lace-up or semirigid ankle brace is more effective than tape or elastic bandages for support 1, 2
• The choice between tape or brace should consider patient preference, but braces generally show superior outcomes 1, 2

Rehabilitation Protocol

• Exercise therapy should begin within 48-72 hours after injury when initial pain and swelling have improved 1, 2

• The rehabilitation program should progress through three phases 1:

  • Phase 1 (0-48 hours): PRICE protocol to minimize pain and swelling
  • Phase 2 (48-72 hours): Begin exercises to restore motion and strength
  • Phase 3: Add endurance training, sport-specific drills, and balance training

• Supervised exercises should focus on 1, 2, 3:

  • Range of motion exercises
  • Strengthening exercises
  • Proprioception and balance training
  • Coordination exercises
  • Sport-specific functional exercises

Follow-up Care

• Re-examination 3-5 days after injury is recommended when pain and swelling have improved to better assess the severity of ligament damage 1, 2
• For a 15-year-old athlete, supervised rehabilitation is particularly important to ensure proper healing and prevent chronic instability 3, 4
• Exercise therapy should be incorporated into regular training activities to prevent recurrent sprains 1, 2

Common Pitfalls to Avoid

• Avoid prolonged immobilization as it shows no benefits compared to functional treatment 1
• Avoid applying heat to the acute ankle injury 1
• Avoid inadequate rehabilitation, which can lead to chronic problems such as decreased range of motion, pain, and joint instability 1, 3
• Avoid unnecessary imaging; radiography is only indicated if criteria from the Ottawa Ankle Rules are met 1, 3
• Avoid unwarranted non-weight bearing; early controlled weight-bearing with appropriate support is beneficial 1, 3

Special Considerations for Adolescents

• For this 15-year-old patient, proper rehabilitation is crucial as inadequate treatment during adolescence can lead to recurrent sprains and chronic instability 1, 4
• Given his weight (200 lbs), proper functional support with a brace rather than tape may be more appropriate to provide adequate stability 1, 2
• Return to sports should only occur after full rehabilitation and when the patient can perform sport-specific movements without pain 1, 3