Initial Treatment for Moderate Ankle Sprain
For a moderate (grade II) ankle sprain, immediately apply a semirigid ankle brace, use NSAIDs for pain control, and begin supervised exercise therapy within 48-72 hours after a brief 3-5 day period of protection and ice application. 1, 2
Immediate Management (First 24-72 Hours)
What NOT to Do
- Do not rely on RICE (Rest, Ice, Compression, Elevation) alone - there is level 1 evidence that RICE by itself has no positive influence on pain, swelling, or patient function 1
- Avoid immobilization completely, as it delays return to work by 7.1 days and return to sports by 4.6 days compared to functional treatment 1, 2
What TO Do
Apply a semirigid ankle brace immediately - this is superior to elastic bandages or tape and is the most cost-effective option 1, 2
Use NSAIDs for pain control:
- Oral or topical NSAIDs reduce pain in the short term (<14 days) without significantly increasing adverse events 1
- Diclofenac shows superior results at days 1-2 compared to other NSAIDs 1
- NSAIDs are associated with improved pain control, decreased swelling, and more rapid return to activity 1
Apply ice with compression - while ice alone is ineffective, cryotherapy combined with exercise therapy shows greater effect on reducing swelling 2
Protect and elevate the ankle for 3-5 days, but no longer 2
Early Mobilization Phase (48-72 Hours Post-Injury)
Begin supervised exercise therapy as soon as possible - this has the strongest evidence (level 1) for effectiveness in ankle sprain rehabilitation 1, 2
Exercise Protocol Components
Supervised exercises must include: 1, 2
- Proprioception training
- Strength exercises addressing muscle deficits
- Coordination exercises
- Functional movement patterns
Key advantage of accelerated exercise: Patients receiving early therapeutic exercise show significantly improved ankle function at week 1 (5.28 point improvement) and week 2 (4.92 point improvement) compared to standard care 3
Common Pitfalls to Avoid
Do not prescribe rest beyond 3-5 days - prolonged immobilization leads to decreased range of motion, chronic pain, and joint instability 1, 2
Do not use unsupervised home exercises initially - supervised exercise provides better outcomes than non-supervised training 2
Do not use elastic bandages as primary support - semirigid supports result in shorter time to return to sports and work, and less ankle instability 1
Be aware that NSAIDs may delay natural healing - the inflammation suppressed by NSAIDs is a necessary component of tissue recovery, though short-term use for pain control is still recommended 1
Timeline for Recovery
Week 1: Focus on pain control with NSAIDs, ice application, semirigid bracing, and initiation of supervised exercise 1, 2
Weeks 2-3: Continue supervised exercises with progressive loading, maintain brace use 2
Weeks 4-6: Progress to sport-specific drills, endurance training, and balance exercises while continuing brace use 1
Continue wearing the semirigid ankle brace for 4-6 weeks total - this is the preferred timeframe outlined in current guidelines 1
Return to Activity
Return to work: With functional treatment, expect return approximately 7 days sooner than with immobilization 1, 2
Return to sports: Functional treatment allows return 4.6 days sooner than immobilization 1, 2
Implement immediate return-to-work schedule to minimize work absenteeism 2
Prevention of Recurrent Injury
Continue wearing the semirigid ankle brace - bracing has level 1 evidence for preventing recurrent sprains and is superior to taping and neuromuscular training alone 2
Incorporate proprioceptive exercises into regular training to reduce risk of future sprains 2