What is the best treatment for Ankle Sprains?

There are many treatments for ankle sprains but the very best treatments cover the main principles of optimal tissue recovery.

For the best outcome, we need to:

1. Manage Pain and Control Swelling
2. Mobilise your foot and ankle as appropriate
3. Do the correct exercise at the correct time 
4. Return to normal activity levels when ready

As a Clinical Specialist Physiotherapist, I see ankle sprains every day in my clinic and they are one of the most common injuries that people sustain. Thankfully with the correct management, we can overcome them and return to activity with confidence. However, when neglected and not managed correctly they can lead to chronic issues later on.

During this blog post, we will look at the way that I manage acute ankle sprains in the clinic every day achieving excellent outcomes. You’ll be able to apply this knowledge to your ankle too.

There are a few different types of ankle sprains but we will be addressing the most common types of ankle sprain, namely Inversion and Eversion sprains.

These occur when you either roll your foot outwards (Eversion) or inwards (Inversion) and overstretch or tear the ligaments supporting the ankle. Ankle sprains can also occur as a result of direct trauma.

When to seek medical attention if you have sustained an ankle sprain

1. There has been a significant amount of trauma and the ankle is misshapen.
2. You have a lot of difficulty putting weight on the leg.
3. Your calf has become hot, swollen, or tender since the incident.
4. Your pain is worsening despite following the advice in this post.

1. Manage Pain and Control Swelling

It may seem like an obvious thing to say but we need to get a handle on the immediate pain post-injury.

You may consider taking some paracetamol or ibuprofen if it is safe for you to do so. Some people choose not to take pain relief and this is also fine. 

The role of paracetamol is to reduce your pain and to give you some relief so that you can perform the next stages of managing the injury.

Ibuprofen is often advised to help with swelling and this can also be helpful for pain relief but by doing so you may be limiting the body’s natural healing process of which inflammation is a natural component.

There is no evidence to support the use of compression for acute ankle sprains but I use them from time to time if the ankle feels unstable to the patient. There is no harm in using a support bandage, taping or ankle support for the first part of your rehabilitation.

I advocate the use of ice for swelling and pain management. Use it for 10 minute blocks up to 5 times per day. Remember not to place the ice directly onto bare skin. You can read my article on the correct application of ice here: Icing Article

Place your leg in an elevated position when resting for the first 24-48 hours post-injury.

Try to avoid long periods on your feet.

2. Mobilise your foot and ankle as appropriate

3. Do the Correct Exercise at the Correct Time

As mentioned in tip no 2, early mobilisation of the ankle is essential and the correct re-application of load is also vital in achieving a great outcome post-injury. 

It’s important not to overstretch the ligaments in the early stages of injury by pushing stretches too hard. Once 78 hours or so have passed and your pain and swelling have started to improve, you can start incorporating some general stretches for the muscles in the calf. These intermediary exercises should involve some light strengthening work such as isometric plantarflexion and dorsiflexion of the ankle. 

After working on the intermediary exercises, and depending on the severity of your sprain, you can start incorporating some balance work and sports specific rehab such as hopping and jumping drills.

It’s essential not to move too quickly through these phases of recovery, this will prevent chronic ankle instability issues. 

If you’re unsure of when to progress consider giving us a call to book an appointment.

4. Return to normal activities when ready

This of course depends entirely on the severity of the sprain. A minor sprain may result in just a 1-2 week absence from sport or usual activity, whereas a complex tear of the ankle ligaments may take up to 3 months before a return to normal activity is possible.

Use this checklist to determine if you may be ready to return to sport or your regular activity:

Return to Sport Check-List

1. You have regained FULL pain pain-free active range of motion of the ankle.
2. You can tolerate sports-specific exercises such as hopping, jumping, change of direction and running.
3.  There is no pain with the above exercises.
4. You should have confidence in your ankle and that you are ready to return to regular activities and if you don’t you need to explore why this may be the case and address these issues.
5. You have good balance and control of the ankle on unstable surfaces. You can practice this with a wobble cushion standing on one leg or even throwing a ball in the air and catching it as you single leg balance.
6. You can complete a full training session for the sport you wish to return to.

This checklist gives you the framework to determine if you should be returning to regular activity and sport. 

If you can not tick off as complete all the above points you need to invest more time in working on the ankle until you can do so.

Conclusion

Good ankle management after a sprain is vitally important but easily managed if you follow the above information.

If in doubt I always tell my patients to take more time before moving on to each stage of recovery. Time invested now in correct rehabilitation will prevent any chronic issues from developing later on.

I wish you all the best with your ankle recovery. If you’re struggling and would like me to help, you can contact me here.