How do I relieve a sprained ankle?

How to Relieve a Sprained Ankle

For immediate relief of an ankle sprain, apply ice and water wrapped in a damp cloth for 20-30 minutes (repeat 3-4 times daily), wear a lace-up or semi-rigid ankle brace, take NSAIDs for pain, and begin weight-bearing as tolerated—avoid prolonged rest beyond 3-5 days. 1, 2

Immediate First Aid (First 24-72 Hours)

Apply cold therapy correctly:

• Use ice mixed with water surrounded by a damp cloth—this provides the most effective tissue cooling 1
• Apply for 20-30 minutes per session, 3-4 times daily 1, 2
• Never place ice directly on skin to prevent cold injury 1
• Cold therapy reduces pain and swelling acutely but does not improve long-term function or recovery time 1

Apply a compression wrap or brace:

• Use a lace-up or semi-rigid ankle brace within the first 48 hours and continue for 4-6 weeks—this is superior to elastic bandages or tape 2
• If using compression wrapping, ensure it does not compromise circulation by avoiding overtightening 1
• Compression may provide comfort in the acute phase, though evidence shows it does not reduce swelling or improve recovery time 1, 3

Elevate the injured ankle:

• Keep the ankle elevated above heart level when possible 2

Avoid activities that cause pain:

• Limit use of the injured extremity initially, but do not completely immobilize 1, 2

Pain Management

Take NSAIDs for pain and swelling:

• Options include ibuprofen, naproxen, diclofenac, or celecoxib 2
• NSAIDs reduce pain and swelling in the short term (<14 days) and may accelerate return to activity 2
• Use acetaminophen if NSAIDs are contraindicated 2
• Avoid opioids—they cause more side effects without superior pain relief 2

Early Mobilization (After 48-72 Hours)

Begin weight-bearing immediately as tolerated:

• Start walking on the ankle as soon as you can tolerate it—early weight-bearing is superior to prolonged rest 2
• Avoid only activities that cause significant pain 1, 2

Start supervised exercise therapy within 48-72 hours:

• This has the strongest evidence (Level 1) for effective recovery 2, 4
• Exercises should include range of motion, proprioception training, strengthening, coordination, and functional movements 2, 4
• Supervised exercises are superior to home exercises alone 2

What NOT to Do (Critical Pitfalls)

Do not immobilize beyond 3-5 days:

• Prolonged immobilization delays recovery by 4.6 days for return to sports and 7.1 days for return to work compared to functional treatment 2
• Immobilization leads to decreased range of motion, chronic pain, and joint instability without any demonstrated benefits 2, 4

Do not rely on RICE protocol alone:

• While individual components (ice, compression, elevation) can be used strategically, the RICE protocol as a standalone treatment has no evidence for effectiveness 2, 4

Do not apply heat in the acute phase:

• Heat application is not recommended for acute ankle injuries 2

Timeline for Recovery

For mild sprains:

• Return to sedentary work at 2 weeks 2
• Full return to work and sports at 3-4 weeks 2

For moderate to severe sprains:

• Return to sedentary work at 3-4 weeks 2
• Full return to work and sports at 6-8 weeks depending on rehabilitation progress 2

When to Seek Medical Attention

Seek immediate medical care if:

• The ankle is blue, purple, or pale (indicating vascular compromise) 1
• There is severe bleeding or an open wound 1
• Pain limits use of the extremity significantly 1

Follow-up at 3-5 days:

• Re-examination helps with accurate diagnosis and treatment planning 2
• Clinical assessment of ligament damage is optimized at 4-5 days post-injury when swelling has decreased 2

Prevention of Recurrent Sprains

Continue ankle bracing during high-risk activities:

• Wear the semi-rigid brace during sports and physical activities even after recovery 2

Incorporate ongoing ankle exercises:

• Continue proprioception and strengthening exercises as part of regular training to prevent recurrence 2, 4