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How Should We Treat Ankle Sprains?

person holding an ice pack on their ankle after an ankle sprain.

There is a lot of inconsistency in the management of acute ankle sprains. You will find recommendations ranging from "walk it off" to booting until tenderness to palpation dissipates. Ankle sprains are common amongst athletes, and rehabilitation recommendations tend between in-season and off-season. The sport, severity of the sprain, time of year, stakes (i.e., playoffs), and type of provider seeing the patient first all influence treatment recommendations.

This umbrella review of 24 systematic reviews aims to provide an overview of different treatment approaches for lateral ankle sprains. While there are many treatment approaches, when breaking them down into large categories, some trends and preferred options emerge. Functional treatment in the acute stage appears to be superior to immobilization. Functional treatment can be a variety of treatment types and may incorporate balance training, manual therapy, and strengthening exercises. The takeaway is that people should be active in a graded manner following an ankle sprain. Surgery does not appear to be superior or necessary with the exception of unstable ankles.

RICE is not the gold standard treatment for acute ankle sprains but it can be used as an adjunct. There is debate amongst clinicians and researchers regarding the use of ice (and compression to a smaller degree). Ice is an effective short-term analgesic. Superficial applications will not blunt the inflammatory response and delay the healing of a ligament or tendon. Prolonged cold water immersion may but that evidence remains conflicting. Overall, graded activity and exposure are the best approaches.

Other therapies (manual, NSAIDs, modalities) can be integrated to reduce pain. There is inconclusive evidence on the effectiveness of external supports.


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