Treatment and Rehabilitation of Ankle Sprains

Classification and Diagnosis

• The American Academy of Family Physicians classifies sprains into three grades: Grade I (Mild) with minimal stretching or microscopic tearing of ligament fibers, Grade II (Moderate) with partial tearing, and Grade III (Severe) with complete ligament tear, each with distinct symptoms and treatment approaches 3

Initial Management

• The British Journal of Sports Medicine recommends functional treatment with early exercise therapy and functional support for all grades of sprains, leading to faster recovery and return to normal activities compared to immobilization 1, 2
• NSAIDs are effective for reducing pain and swelling in the acute phase, with diclofenac showing superior results for pain reduction during the first 48 hours compared to ibuprofen, according to the American Family Physician and British Journal of Sports Medicine 1, 3, 4

Rehabilitation Protocol

• The British Journal of Sports Medicine suggests a rehabilitation protocol that includes early range of motion exercises, progressive weight-bearing, and supervised exercise therapy focusing on proprioception, strength, and coordination, with the goal of returning to normal activities within 1-12 weeks depending on the grade of the sprain 1, 2
• The protocol is divided into phases: acute (1-7 days), subacute (1-3 weeks), and functional (2-6 weeks), each with specific exercises and goals, such as controlling pain and swelling, progressing to strengthening exercises, and including proprioceptive training on stable and unstable surfaces 1, 2

Prevention of Recurrence

• The American Academy of Family Physicians and British Journal of Sports Medicine recommend semirigid or lace-up ankle supports to decrease the risk of recurrent injury, especially in patients with a history of sprains, as well as graded exercise regimens involving proprioceptive elements such as ankle disk training 1, 3
• Supervised exercises show better outcomes compared to non-supervised training in preventing recurrence, according to the British Journal of Sports Medicine 1, 2

Common Pitfalls to Avoid

• Complete immobilization leads to muscle atrophy, joint stiffness, and delayed recovery, while premature return to full activity increases risk of re-injury and chronic instability, according to the British Journal of Sports Medicine and Praxis Medical Insights 1, 4
• Relying solely on passive treatments is ineffective; active rehabilitation with progressive exercises is essential, as stated by Praxis Medical Insights 4