Initial treatment commonly consists of
rest, icing, compression and elevation (which is often referred to by the mnemonic RICE or sometimes PRICE with P being "protection"). These elements have been recommended by physicians for decades for the treatment of soft tissue damage, and sprained ankles, one of the most common soft tissue injuries. RICE helps limit the amount of swelling to the area, and "facilitates venous and lymphatic drainage". and the National Athletic Trainers Association notes that most of the rationale for using RICE or individual components is based largely on low-quality clinical trials and laboratory studies with uninjured participants or animal models. For most ankle sprains, functional treatment is generally preferred over immobilization. Studies have shown patients return back to normal activities sooner when management is focused on restoring ankle function - typically by using braces, taping or elastic bandages, rather than complete immobilization such as a plaster casting. Functional treatment generally consists of three phases: the first is the RICE regime (rest, ice, compression, elevation) in the first 24 to 48 hours to reduce swelling and pain. The second phase is range of motion and ankle strengthening exercises within 48 to 72 hours. Finally the third phase involves progressive endurance and balance training during recovery.
Conservative measures Ice is often used to reduce swelling in cycles of 15–20 minutes on and 20–30 minutes off. Icing an ankle too long can cause cold injuries, which is indicated by the area turning white. Also, it is often recommended that ice not be applied directly to the skin, but should have a thin buffer between the ice and the affected area, and some professionals think ice need not be applied at all. Recently,
Gabe Mirkin, MD, who coined and popularized the acronym RICE in his
The Sportsmedicine Book in 1978, no longer recommends "complete" rest or ice for healing a sprain. After reviewing modern studies, he notes that because ice closes off the blood vessels, "ice doesn't increase healing—it delays it," and "complete Rest may delay healing." He now advises skipping ice altogether unless needed to reduce pain from swelling. A small but growing number of doctors no longer recommend RICE for sprains. In uncomplicated lateral ankle sprains, swelling of the soft tissue can be prevented with compression around both malleoli, elevation of the injured ankle higher than the heart, and pain-free exercises. An orthopedic
walking boot is often used for the treatment of a sprained ankle injury. Braces and crutches are also used to help alleviate the pain so the injured ankle can heal as quickly and painlessly as possible. Although found to be less effective than casts, compression bandages are used to provide support and compression for sprained ankles. Wrapping is started at the ball of the foot and slowly continued up to the base of the calf muscle; this allows the swelling to travel up toward the center of the body so that it does not gather in the foot. In addition, other external supports such as Kinesio taping does not "improve ankle functioning or performance in people with or without ankle injuries." The "current evidence does not support or encourage the use of Kinesio taping applied to the ankle for improvements in functional performance, regardless the population." This can be done instantly by implementing the
RICE mechanism which is resting the ankle, applying ice, compressing, and elevating it. The emphasis of the first week of rehabilitation should be on protecting the ankle to avoid further damage. As the healing progresses, stress can be applied by different mechanisms until the ankle is fully recovered. The key to a fast recovery is to implement all the different types of ankle sprain exercises so that the
range of motion will increase while the pain is decreasing. In cases where the ankle does not heal in an appropriate amount of time, other exercises need to be implemented so that strength and flexibility can be regained.
Physical therapists assign different types of ankle sprain exercises that deal with ankle flexibility, strengthening, balance, and
agility. If an ankle sprain does not heal properly, the joint may become unstable and may lead to
chronic pain. Receiving proper treatment and performing exercises that promote ankle function is important to strengthen the ankle and prevent further injury.
Ankle immobilization A short period of
immobilization in a below-knee cast or in an Aircast leads to a faster recovery at 3 months compared to a tubular compression bandage. In contrast, a
randomized controlled trial has concluded that appropriate exercise immediately after a sprain improves function and recovery. These exercises were focused on increasing ankle range of movement, activation and strengthening of ankle musculature, and restoring normal sensorimotor control, and were carried out for 20 minutes, three times a day. The amount of therapy that a person can handle will depend on their level of pain and the grade of sprain they experienced. It is not recommended to return to sports or extreme physical activities until hopping on the ankle is possible without pain. Wearing
high-top tennis shoes may also help prevent ankle sprains if the shoes used are laced snugly and if the ankle is taped with a wide, nonelastic adhesive tape.
Ankle mobilization/manipulation For acute ankle sprains, manual
joint mobilization/
manipulation of the ankle has been found to diminish pain and increase range of motion. For treatment of subacute/chronic lateral ankle sprains, these techniques improved ankle range-of-motion, decreased pain and improved function.
Ankle exercises To prevent sprains or re-injury from occurring, strengthening and stretching exercises should be done through a full range of ankle motion. To improve ankle mobility, ankle circles can be performed by extending the legs in front of the body and then moving the foot up and down, side to side, or rotating the foot in a circle. Another common exercise to improve mobility, as well as proprioception, is to use the toes to draw the letters of the alphabet in the air. Most importantly, the lateral aspect of the ankle joint should be strengthened with eversion exercises (i.e., underside of the foot is turned outward against resistance) to improve lateral ankle stability. Stretching is also an important component of a strengthening program, to help maintain joint flexibility. Balance and stability training are especially important to retrain the ankle muscles to work together to support the joint. This includes exercises that are performed by standing on one foot and using the injured ankle to lift the body onto its toes. To further enhance balance and stability, exercise devices such as the
wobble board can be used, progressing from double-leg to single-leg stance, first with eyes open and then with eyes closed, for enhanced effectiveness.
Flexibility exercises Flexibility exercises include a towel stretch and writing the alphabet with the toes, which will increase the range of motion.
Strengthening exercises Ankle strengthening exercises are step ups and walking on toes which will strengthen the muscles around the swollen area. Rehabilitation exercises to strengthen the ankle has been shown to reduce the risk of re-injuring. Exercise prescription isn't clearly understood and deserves further research.
Balance exercises Balance exercises include the use of a
balance board, which helps the whole body function to maintain balance. The use of balance boards has been shown to produce significantly positive results in gaining proper balance.
Agility exercises Plyometrics exercises such as
squat jumps and power skipping should not be implemented until the ankle has regained full agility. Other strategies that can be used to prevent ankle injury include: • Ensure proper warm-up prior to stretching and activity; • When running, choose level surfaces and avoid rocks or holes; • Ensure that shoes have adequate heel support; • If high-heeled shoes are worn, ensure that heels are no more than two inches in height, and avoid heels with a narrow base. == Prognosis ==