What is the treatment for a grade 2 ankle sprain?

Treatment for Grade 2 Ankle Sprain

For a grade 2 ankle sprain, immediately apply a lace-up or semi-rigid ankle brace (not elastic bandage) within 48 hours and continue for 4-6 weeks, combined with supervised exercise therapy starting within 48-72 hours—avoid prolonged immobilization beyond initial pain control as it delays recovery without improving outcomes. 1

Immediate Management (First 48 Hours)

PRICE Protocol Components

• Apply cold (ice and water surrounded by damp cloth) for 20-30 minutes per application without direct skin contact to prevent cold injury 1
• Use compression with a lace-up or semi-rigid ankle brace—this is superior to elastic bandages or tape and leads to faster return to sports (4.6 days sooner) and work (7.1 days sooner) compared to immobilization 1
• Elevate the ankle and protect from further injury 1
• Critical pitfall: Do not use elastic tubular bandages (Tubigrip) as they show no positive effect on functional recovery and may increase analgesic requirements 1, 2

Weight-Bearing Protocol

• Begin weight-bearing as tolerated immediately after injury, avoiding only activities that cause pain 1
• Do not immobilize beyond what is needed for initial pain control (3-5 days maximum) 1, 3

Pain Management

First-Line Pharmacotherapy

• Use NSAIDs (ibuprofen, naproxen, diclofenac, celecoxib, or piroxicam) for short-term pain control (<14 days) to reduce pain and swelling, which accelerates return to activity 1
• Acetaminophen is equally effective if NSAIDs are contraindicated 1
• Avoid opioids as they cause significantly more side effects without superior pain relief 1

Supervised Exercise Therapy (Level 1 Evidence)

Timing and Structure

• Begin supervised exercise therapy within 48-72 hours after injury—this has the strongest evidence (Level 1) for effectiveness 1, 3
• Supervised exercises are superior to home exercise programs alone 1

Exercise Components (All Required)

• Range of motion exercises to restore joint mobility 1
• Proprioception training (critical to prevent recurrent sprains, especially after previous ankle injuries) 1
• Strengthening exercises targeting ankle and surrounding musculature 1, 3
• Coordination and functional exercises specific to activity demands 1

Manual Therapy Adjunct

• Manual mobilization can be added to enhance treatment effects but should never be used alone—only in combination with exercise therapy 1, 3

Return to Activity Timeline for Grade 2 Sprains

• Return to sedentary work: 3-4 weeks 1
• Full return to work and sports: 6-8 weeks depending on physiotherapy results and task requirements 1
• Continue wearing the semi-rigid ankle brace during high-risk activities even after recovery 1

Prevention of Chronic Problems

Long-Term Exercise Integration

• Incorporate ongoing ankle exercises into regular training activities after recovery—this has high cost-benefit ratios due to reduced recurrence rates 1
• Continue ankle bracing during high-risk activities (Level 2 evidence for preventing recurrent sprains) 1

Follow-Up Assessment

• Re-examine at 3-5 days after injury for accurate diagnosis and treatment planning 1
• Clinical assessment of ligament damage is optimized if delayed 4-5 days post-injury when swelling has decreased 1, 3

Critical 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, 3
• Do not use RICE protocol alone: Individual components can be used strategically, but RICE alone has no evidence for effectiveness 1, 3
• Do not prescribe unsupervised home exercises only: Supervised therapy produces superior outcomes 1
• Do not apply heat in the acute phase: Cryotherapy combined with exercise therapy is more effective for reducing swelling 3
• Inadequate treatment leads to chronic problems in over 70% of patients, with up to 80% experiencing recurrent sprains 1, 4