Sprain Management
Start functional treatment immediately with a brace and supervised exercise therapy within 48-72 hours—avoid immobilization beyond initial pain control as it delays recovery without any demonstrated benefit. 1, 2
Immediate Management (First 48 Hours)
Avoid RICE alone as a treatment strategy—while individual components can be used strategically, the protocol as a whole lacks evidence for effectiveness as a standalone treatment. 1, 2
Apply These Components Selectively:
Protection and functional support: Apply a lace-up or semi-rigid ankle brace within the first 48 hours and continue for 4-6 weeks—this is superior to immobilization and leads to faster return to sports (4.6 days sooner) and work (7.1 days sooner). 3, 2
Ice application: Apply cold therapy (ice and water surrounded by a damp cloth) for 20-30 minutes per application without direct skin contact to prevent cold injury—use for pain and swelling control only. 1, 2
Compression: Apply a compression wrap to promote comfort, ensuring circulation is not compromised. 2
Elevation: Elevate the injured extremity to reduce swelling. 2
Weight-bearing: Begin weight-bearing as tolerated immediately after injury, avoiding only activities that cause pain—do not enforce non-weight-bearing periods. 2
Pain Management
NSAIDs are the first-line pharmacologic option for reducing pain and swelling in the acute phase (first 14 days), which accelerates return to activity. 1, 2
NSAID options: Ibuprofen, naproxen, diclofenac, piroxicam, or celecoxib are all effective choices. 2
Alternative: Acetaminophen is equally effective if NSAIDs are contraindicated. 2
Avoid opioids: They cause significantly more side effects without superior pain relief compared to NSAIDs. 2
Exercise Therapy Protocol (Start Within 48-72 Hours)
Supervised exercise therapy has Level 1 evidence for effectiveness and should begin within 48-72 hours after injury—this is the strongest recommendation in sprain management. 3, 2
Exercise Program Components:
Range of motion exercises: Initiate early to prevent stiffness and maintain joint functionality. 1, 2
Proprioception training: Critical for preventing recurrent sprains, especially in patients who have already had two sprains. 2
Strengthening exercises: Address muscle strength deficits that occur after sprains. 3, 2
Coordination and functional exercises: Progress to sport-specific movements as tolerated. 3, 2
Supervised exercises are superior to non-supervised training—patients should work with a physical therapist rather than performing home exercises alone. 3
Manual Therapy
Manual mobilization should only be used in combination with other treatment modalities to enhance treatment effects—never use it as a standalone intervention. 1, 2
Follow-Up Assessment
Re-examine the patient 4-5 days post-injury when swelling has decreased—this allows for accurate assessment of ligament damage severity and optimization of the treatment plan. 1, 2
Return to Activity Timeline
For Mild Sprains:
- Return to sedentary work: 2 weeks 2
- Full return to work and sports: 3-4 weeks depending on task requirements 2
For Moderate to Severe Sprains:
- Return to sedentary work: 3-4 weeks 2
- Full return to work and sports: 6-8 weeks depending on physiotherapy results 2
Prevention of Recurrent Sprains
Continue ankle bracing during high-risk activities even after recovery from the initial injury. 2
Incorporate ongoing ankle exercises into regular training activities—this has high cost-benefit ratios due to reduced recurrence rates. 3, 2
Neuromuscular training and ankle braces have Level 2 evidence for preventing recurrent sprains through reduced societal costs. 3
Common Pitfalls to Avoid
Do not immobilize beyond 3-5 days: Prolonged immobilization leads to decreased range of motion, chronic pain, and joint instability without any demonstrated benefits. 1, 2
Do not delay exercise therapy: Early movement promotes better healing—waiting beyond 48-72 hours delays recovery unnecessarily. 1
Do not use heat application: Heat is not recommended for acute ankle injuries. 2, 4
Do not rely on RICE alone: While components can be used strategically, RICE as a complete protocol lacks evidence as a standalone treatment. 1, 2
Do not skip supervised therapy: Non-supervised home exercises produce inferior outcomes compared to supervised rehabilitation. 3
Special Considerations
Surgery is only indicated for professional athletes requiring rapid recovery or patients whose complaints are not resolved by conservative treatment after appropriate rehabilitation. 1
For pregnant patients, the same functional treatment approach applies with careful consideration of medication safety—lace-up or semirigid ankle supports are preferred, and functional rehabilitation should begin within 48-72 hours. 4