Ankle Sprain: Acute Phase Care

You’re out on the trail or playing a pick-up game of basketball, when the dreaded ‘ankle turn’ occurs. Sometimes we hear a pop, sometimes we just hit the deck with searing pain, sometimes it swell immediately, sometimes it doesn’t…what you need to know is what to do!

An inversion or lateral ankle sprain usually takes a toll on the ATFL (anterior talofibular ligament), but it can wreak havoc on other ligaments on the outside and inside of the ankle as well as musculature and soft tissue further up the leg. You can also suffer an eversion sprain which stresses the deltoid ligament of the ankle greatly, acute phase care is similar if not identical for this injury.

Do i need an x-ray?

The Ottawa Ankle Rules are a good standard to know whether your should seek imaging right away, but a good rule of thumb is if you can’t bear weight or walk (even with a limp) within 12-24 hours you should probably seek a medical consult and possible imaging.

Should you ice?

You can use ice for the first 24 hours to control severe swelling and to reduce pain. Swelling and inflammation are normal healing processes so we don’t want to quell them too quick or too much. The same goes for NSAID (non-steroidal anti-inflammatory drugs) use (ibuprofen/naproxen) these have been shown to reduce healing of tendon/ligament injuries as well as slow down muscle recovery, so use only as need for pain mitigation. Devices such as Compex, MarcPro and Normatec can greatly aid in recovery and swelling reduction in the acute phase. It can also help to get your feet elevated above the level of your heart when you are off your feet, this helps increase blood flow return out of your ankle back to your heart. Also kinesio tape or stretch tape can be used to reduce swelling and bruising.


Should i use a brace/air cast?

As we mentioned movement early and often is key, so if you don’t fall into the criteria of seeking medical help and you can bear weight a brace provides little help to stabilize, and an air cast should only be used if a medical deems it necessary. Walking boots may be prescribed if acute or avulsion fractures have occurred. Compressive sleeves can help reduce swelling and increase feedback to the ankle in the acute and sub-acute phase as well as return to play, this is our top choice for compressive sleeve by CEP.

What does early phase rehab look like?

In the olden days (maybe 5 years ago) we used to rest everything until we would be left with a swollen, nicely bruised and stiff ankle. Now we know movement, early and often is the key to quicker recovery and better long-term outcomes. Try to get barefoot as much as possible when both surface and environment allow, this will help keep your feet ‘awake’ as your nervous system is trying to subdue stimulus to the injured ankle.

Try these exercises below for the first week post ankle sprain.

Perform 3-4 times throughout the day.

Demonstrating ankle Controlled Articular Rotations (CARs) via Functional Range Conditions (FRC). Great drill for increased ankle mobility and stability.

Triplanar ankle mobilizations are a great drill to work on multi-planar mobility and propioception of the ankle-mortisse joint. Ankle dorsiflexion is a crucial movement and this drill can help reintegrate it into the kinematic chain.

Sinlge-leg deadlifts are great progression or scale from our typical bilateral or standard deadlift.