Ankle Sprain Treatment
Implement the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) immediately, followed by early functional rehabilitation with a semirigid ankle brace and supervised exercise therapy beginning within 48-72 hours after injury. 1
Immediate Acute Management (First 3-5 Days)
- Apply ice (surrounded by a damp cloth) for 20-30 minutes at a time to reduce pain and swelling, avoiding direct skin contact to prevent cold injury 1
- Use a compression wrap to promote comfort while ensuring circulation is not compromised 1
- Elevate the injured ankle above heart level 1
- Apply a semirigid ankle brace immediately—this is the most cost-effective option and superior to taping or elastic bandages 1, 2
- Consider NSAIDs to reduce pain and swelling in the acute phase, which may decrease time to return to usual activities 1, 2
- Avoid heat application for acute ankle injuries 1
Early Functional Rehabilitation (Starting 48-72 Hours Post-Injury)
Functional treatment with early mobilization is strongly preferred over prolonged immobilization, as it results in return to sports 4.6 days sooner and return to work 7.1 days sooner 1, 2
Begin supervised exercise therapy as soon as possible after the initial 3-5 day RICE period—this has the strongest evidence (level 1) for effectiveness 1, 2
Supervised exercises are superior to non-supervised home programs and must include: 1, 2
- Range of motion exercises
- Proprioception training (balance and position sense)
- Strengthening exercises targeting muscle deficits
- Coordination exercises
- Sport-specific functional activities
Continue wearing the semirigid ankle brace during rehabilitation and return to activity, as bracing has level 1 evidence for preventing recurrent sprains 2
Follow-Up and Reassessment
- Schedule re-examination 3-5 days after injury for accurate diagnosis and treatment planning, as clinical assessment of ligament damage is optimized when swelling has decreased 1, 2
- Manual mobilization may be added only in combination with other treatment modalities to enhance treatment effect 1, 2
Special Consideration: High Ankle Sprains
- High ankle sprains (syndesmosis injuries) can be detected using the crossed-leg test, where pressure applied to the medial knee produces pain in the syndesmosis area 1, 2
- These injuries require more intensive rehabilitation and longer recovery time 1
- The same functional treatment principles apply, but expect extended timelines 2
Critical Pitfalls to Avoid
- Avoid prolonged immobilization—it shows no benefits compared to functional treatment and delays recovery 1, 2
- Do not apply heat to acute ankle injuries 1
- Inadequate rehabilitation leads to chronic problems including decreased range of motion, persistent pain, and joint instability 1, 2
- RICE alone without subsequent exercise therapy has no positive influence on long-term patient function 2
- Excessive rest beyond 3-5 days delays recovery and return to activities 2
Prevention of Recurrent Injury
- Continue wearing a semirigid ankle brace during high-risk activities—bracing is superior to taping and neuromuscular training for preventing recurrent sprains (level 1 evidence) 2
- Incorporate proprioceptive and neuromuscular training exercises into regular training activities for athletes with recurrent sprains 1, 2