What is the recommended treatment plan for a 16-year-old male (16yoM) with two right ankle sprains who can still bear weight but experiences pain?

Recommended Treatment Plan for 16-Year-Old Male with Two Right Ankle Sprains

Start functional support with a brace for 4-6 weeks combined with immediate supervised exercise therapy, and consider NSAIDs for pain control. 1

Immediate Management (First 3-5 Days)

Avoid RICE protocol alone as it has no evidence for effectiveness in treating ankle sprains. 1 However, you can use individual components strategically:

• Apply ice for 20-30 minutes, 3-4 times daily, using ice and water surrounded by a damp cloth (never directly on skin) to reduce pain and swelling. 2, 3
• Elevate the leg above heart level when resting. 2
• Apply compression wrap for comfort, ensuring circulation is not compromised. 3
• Allow weight-bearing as tolerated—since he can bear weight, encourage this rather than complete rest. 4

Functional Support (Critical Component)

Use a lace-up or semi-rigid ankle brace for 4-6 weeks. 1, 3 This is superior to immobilization and leads to:

• Return to sports 4.6 days sooner than immobilization. 3
• Return to work 7.1 days sooner than immobilization. 3

Do not immobilize the ankle beyond what's needed for initial pain control, as this delays recovery without improving outcomes. 1, 3

Exercise Therapy (Highest Level of Evidence)

Begin supervised exercise therapy within 48-72 hours after injury. 1, 3 This has level 1 evidence for effectiveness and should include:

• Range of motion exercises to restore joint mobility. 3, 5
• Proprioception training to prevent recurrent sprains (critical since he has already had two sprains). 1, 3, 5
• Strengthening exercises targeting ankle and surrounding muscles. 2, 5
• Coordination and functional exercises progressing to sport-specific movements. 1, 3, 5

Manual mobilization can be added to enhance treatment effects but should not be used alone. 1

Pain Management

NSAIDs are effective for reducing pain and swelling in the short term (<14 days). 1, 3 Options include:

• Ibuprofen, naproxen, diclofenac, or celecoxib—all are similarly effective. 1
• Acetaminophen is equally effective as NSAIDs for pain, swelling, and range of motion if NSAIDs are contraindicated. 1
• Avoid opioids as they cause significantly more side effects without superior pain relief. 1

Critical Pitfalls to Avoid

• Do not delay exercise therapy beyond 48-72 hours—early mobilization is essential for optimal recovery. 1, 3, 5
• Do not prolong immobilization—this is the most common mistake and significantly delays recovery. 5, 4
• Do not skip proprioception training—with two previous sprains, he is at high risk for recurrence (up to 80% will re-sprain without proper rehabilitation). 6, 7
• Do not rely on home exercises alone—supervised exercise therapy is superior to unsupervised programs. 7

Follow-Up Assessment

Re-examine at 4-5 days post-injury when swelling has decreased, allowing more accurate assessment of ligament damage severity. 1, 3 This helps determine if more intensive rehabilitation is needed.

Prevention of Future Sprains

Since this is his second sprain, incorporate ongoing ankle exercises into regular training activities to prevent recurrence. 1 Continue using ankle bracing during high-risk activities even after recovery. 3, 4