How To Treat Ankle Sprains

Ankle sprains are common injuries that can range from mild to severe. The treatment approach depends on the severity of the sprain. Here are the general treatment options categorized by severity:

General Treatment Approach for Ankle Sprains

Initial Treatment: R.I.C.E. Protocol

Regardless of the severity, initial treatment typically follows the R.I.C.E. protocol:

1. Rest

   • Avoid putting weight on the injured ankle. Use crutches if necessary.

2. Ice

   • Apply ice packs to the injured area for 15-20 minutes every 2-3 hours during the first 48-72 hours to reduce swelling and pain.

3. Compression

   • Use an elastic bandage or ankle brace to compress the ankle and limit swelling. Ensure it’s snug but not too tight to cut off circulation.

4. Elevation

   • Keep the ankle elevated above heart level as much as possible to reduce swelling.

Severity-Based Treatment

Grade I (Mild Sprain)

• Characteristics: Mild stretching and microscopic tearing of the ligament fibers. Mild tenderness and swelling.
• Treatment:
  • Continue the R.I.C.E. protocol for the first 48-72 hours.
  • Over-the-counter pain relievers (e.g., ibuprofen or acetaminophen).
  • Begin gentle range-of-motion exercises as pain allows.
  • Gradually resume normal activities as pain decreases.
  • Ankle support (brace or taping) during activities that put stress on the ankle.

Grade II (Moderate Sprain)

• Characteristics: Partial tearing of the ligament. Moderate pain, swelling, and bruising. Some instability in the joint.
• Treatment:
  • R.I.C.E. protocol for the first 48-72 hours.
  • Use of an ankle brace or splint to immobilize and protect the joint.
  • Physical therapy to restore range of motion, strength, and stability.
  • Gradual return to activity with the use of ankle support.
  • Pain management with NSAIDs (non-steroidal anti-inflammatory drugs).

Grade III (Severe Sprain)

• Characteristics: Complete tear of the ligament. Severe swelling, pain, bruising, and significant instability.
• Treatment:
  • R.I.C.E. protocol for the first 48-72 hours.
  • Immobilization with a splint, cast, or boot for a period of time.
  • Referral to a specialist for further evaluation, especially if there is significant instability.
  • Physical therapy focusing on regaining range of motion, strength, and proprioception.
  • Possible surgical intervention if there is persistent instability or if the ligament does not heal properly.

Rehabilitation and Recovery

1. Physical Therapy

   • Essential for restoring function, strength, and stability.
   • Exercises include:
     • Range-of-Motion Exercises: To prevent stiffness.
     • Strengthening Exercises: To strengthen the muscles around the ankle.
     • Balance and Proprioception Exercises: To improve joint stability and prevent future sprains.

2. Gradual Return to Activities

   • Start with low-impact activities (e.g., swimming or cycling) before progressing to higher-impact sports or activities.
   • Use protective devices like ankle braces during high-risk activities.

3. Functional Testing

   • Assessing readiness to return to sports or strenuous activities through functional tests supervised by a physical therapist or healthcare provider.

Prevention of Future Sprains

1. Strengthening Exercises

   • Regularly perform exercises to strengthen the muscles around the ankle.

2. Balance Training

   • Incorporate balance exercises into your routine to improve proprioception and joint stability.

3. Proper Footwear

   • Wear shoes that provide adequate support and stability.

4. Taping or Bracing

   • Use ankle supports during high-risk activities, especially if you have a history of ankle sprains.

When to Seek Medical Attention

• Persistent Pain or Swelling: If symptoms do not improve with initial treatment.
• Significant Instability: Feeling that the ankle is giving way.
• Inability to Bear Weight: Severe pain when trying to stand or walk.
• Visible Deformity: Possible sign of a fracture or severe ligament damage.

Summary

Ankle sprain treatment varies depending on the severity of the injury, ranging from home-based R.I.C.E. therapy and over-the-counter pain medications for mild sprains to immobilization, physical therapy, and possibly surgery for more severe cases. Rehabilitation is crucial for recovery and preventing future injuries. Always seek medical advice if you suspect a severe sprain or if symptoms do not improve with initial treatment.

Author

Dr. Catherine Logan, MD, MBA Catherine Logan, MD, MBA, MSPT, is a sports medicine orthopaedic surgeon specializing in complex knee and shoulder surgery at Colorado Sports Medicine and Orthopaedics (COSMO) in Denver, Colorado. As a former physical therapist & trainer, Dr. Logan provides a distinct expertise in sports injury, prevention, and surgical management.