What is the best treatment for ankle strain?

Treatment of Ankle Strain

Implement functional treatment immediately with the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) combined with a semirigid ankle brace, followed by supervised exercise therapy starting within 48-72 hours—avoid prolonged immobilization as it delays recovery and provides no benefit. 1, 2

Immediate Acute Management (First 3-5 Days)

Apply the PRICE Protocol:

• Protection: Use a semirigid ankle brace immediately—this is superior to tape or elastic bandages and is the most cost-effective option 1, 2
• Rest: Limit weight-bearing for 3-5 days, avoiding activities that cause pain 1, 3
• Ice: Apply cold (ice and water surrounded by damp cloth) for 20-30 minutes per session, never directly on skin to prevent cold injury 1, 3
• Compression: Apply compression wrap to promote comfort while ensuring circulation is not compromised 1
• Elevation: Keep ankle elevated above heart level 3

Pharmacological Management:

• NSAIDs (piroxicam, celecoxib, or naproxen) should be used to reduce pain and swelling, which accelerates return to activity 1, 3, 2

Early Mobilization Phase (48-72 Hours Post-Injury)

Begin supervised exercise therapy within 48-72 hours—this has Level 1 evidence as the most effective treatment for ankle sprains and significantly improves outcomes compared to rest alone. 1, 2, 4

The exercise protocol must include:

• Range of motion exercises 1, 2
• Progressive strengthening exercises targeting muscle deficits 2
• Proprioception training (balance and coordination exercises) 1, 2
• Functional exercises specific to the patient's activities 1, 2

Key Evidence: Accelerated rehabilitation with early therapeutic exercise improves ankle function significantly at week 1 and week 2 compared to standard RICE alone, with patients being more active during recovery (higher step counts and walking time). 4

Functional Treatment vs. Immobilization

Never use prolonged immobilization—functional treatment with bracing demonstrates clear superiority:

• Return to sports occurs 4.6 days sooner than with immobilization 1, 3
• Return to work occurs 7.1 days sooner than with immobilization 1, 3
• Immobilization shows no benefits and should be avoided 2

Lace-up or semirigid ankle supports are more effective than tape or elastic bandages for functional support during recovery. 1

Ongoing Rehabilitation and Prevention

Continue semirigid bracing throughout rehabilitation and upon return to sport—this has Level 1 evidence for preventing recurrent sprains, which is superior to taping or neuromuscular training alone. 3, 2

Manual mobilization should only be used in combination with other treatment modalities, not as standalone therapy. 1, 2

Follow-Up and Assessment

Re-examine at 3-5 days post-injury for accurate diagnosis and treatment planning, as clinical assessment of ligament damage is optimized when swelling has decreased. 1, 2

For recurrent ankle sprains, exercise therapy should be incorporated into regular training activities. 2

Critical Pitfalls to Avoid

• Never apply heat to acute ankle injuries—cryotherapy combined with exercise is superior for reducing swelling 1, 2
• RICE alone has no positive influence on pain, swelling, or patient function without the addition of early exercise therapy 2
• Inadequate treatment leads to chronic problems including decreased range of motion, pain, and joint instability 1, 2
• Supervised exercise is superior to non-supervised training—patients should receive professional guidance for optimal outcomes 2

Special Consideration: High Ankle Sprains

If the mechanism involves dorsiflexion with external rotation or the crossed-leg test (squeeze test) produces pain in the syndesmosis area, this indicates a high ankle sprain requiring more intensive rehabilitation and significantly longer recovery time. 3, 2