Patient Counseling for Ankle Sprain
Counsel patients to avoid activities that cause pain, apply ice for 20-30 minutes at a time, use a lace-up or semirigid ankle brace (not an elastic bandage), and begin supervised exercise therapy within 48-72 hours to restore function and prevent chronic instability. 1
Immediate Actions and Activity Modification
- Instruct patients to immediately stop any activity that causes pain and seek medical evaluation if the injury significantly limits use of the extremity 1
- Explain that attempting to "push through" pain or returning to sports/work too early increases the risk of chronic instability, which occurs in 20% of ankle sprains 2
- Emphasize that over 70% of people who receive inadequate treatment continue to have ongoing problems, and up to 80% will re-sprain their ankle 3
Ice Application Technique
- Apply cold therapy using ice and water surrounded by a damp cloth for 20-30 minutes per application, 3-4 times daily 1
- Warn patients never to place ice directly on skin, as this can cause cold injury 1
- Clarify that while ice helps with pain and swelling in the first 1-4 weeks, it does not speed overall recovery time 1
Ankle Support Selection
- Recommend a lace-up or semirigid ankle brace rather than tape or elastic bandages, as these are significantly more effective 1, 4
- Explain that semirigid supports result in returning to sports 4.6 days sooner and returning to work 7.1 days sooner compared to immobilization 4
- Instruct patients to ensure the compression wrap is snug but not so tight that it compromises circulation (check for numbness, tingling, or color changes) 1
Exercise Therapy Timeline
- Counsel patients that supervised exercise therapy should begin within 48-72 hours after injury, not weeks later 1, 4
- Explain that early therapeutic exercise (starting in the first week) significantly improves ankle function compared to rest alone 5
- Emphasize that supervised exercises focusing on proprioception, strength, coordination, and function have the strongest evidence (level 1) for preventing chronic problems 1, 4
What NOT to Do
- Advise against prolonged immobilization or complete rest, as this provides no benefit and delays recovery 1, 4
- Explain that the traditional "RICE" protocol alone (rest, ice, compression, elevation without exercise) has no positive influence on long-term function 1, 6
- Warn against using heat application for acute ankle injuries 4, 7
Pain Management Options
- Inform patients that NSAIDs (such as ibuprofen or naproxen) may be used to reduce pain and swelling in the acute phase 1, 4
- Clarify that pain medication addresses symptoms but does not replace the need for functional rehabilitation 1
Follow-Up Expectations
- Schedule re-examination 3-5 days after injury for accurate assessment of ligament damage, as initial swelling obscures the clinical exam 4, 7
- Explain that this delayed examination helps determine the severity of injury and guides the treatment plan 1, 4
Prevention of Re-Injury
- Strongly recommend continuing to wear the ankle brace during sports and high-risk activities even after symptoms resolve, as this has level 1 evidence for preventing recurrent sprains 1
- Counsel patients to continue proprioception and balance exercises as part of their regular training routine indefinitely 1, 4
- Explain that functional support is most effective for those with previous ankle sprains, reducing recurrence risk significantly 1
Red Flags Requiring Immediate Medical Attention
- Instruct patients to activate emergency services if they experience inability to bear weight, severe deformity, loss of sensation, or signs of compromised circulation 1
- Warn that persistent or worsening pain beyond the expected timeline may indicate complications such as occult fractures, cartilage damage, or tendon injury requiring advanced imaging 8