Ankle Sprain and Strain Treatment Options

Many ankle sprains and strains heal on their own within four to six weeks if the patient rests the ankle and avoids strenuous activity until the healing process has completed.

Grade 1 and 2 Ankle Sprains and Strains

For Grade 1 and Grade 2 sprains, most doctors recommend the RICE protocol, which stands for Rest, Ice, Compression, and Elevation:

Rest. Patients are advised to not walk or stand on the sprained or strained ankle until healing is complete. The rest period can range from a day or two for Grade 1 sprains or strains to several weeks or months for Grade 3 sprains or strains.

Ice. Applying cloth-wrapped ice packs to the injury site as soon as possible after the injury occurs is strongly recommended. The ice helps reduce swelling and pain. Ice packs may be applied for 20 to 30 minutes at a time, three to four times daily. Patients are advised to avoid more frequent icing schedules or applying ice directly to the skin, which can cause tissue damage.

Compression. Wrapping the ankle with ACE bandages, commercial compression dressings, or athletic tape helps to immobilize and support the injury site. This immobilization and compression promotes healing and can help prevent aggravation of the injury. Patients with mild sprains and strains can wrap their ankles themselves, while more severe injuries should be compressed/immobilized by a qualified medical professional.

Elevation. Elevating the ankle above the level of the heart for the first 48 hours following the injury can help reduce swelling, alleviate some discomfort, and jump-start the healing process.

See The P.R.I.C.E. Protocol Principles

NSAIDs and acetaminophen. Patients with Grade 1 or 2 sprains and strains can benefit from taking non-steroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil), which can help reduce inflammation at the injury site while offering pain relief. Acetaminophen (Tylenol) can also provide pain relief.¹American Academy of Family Physicians. Ankle sprains: healing and preventing injury. FamilyDoctor.org, December 2010. http://familydoctor.org/familydoctor/en/prevention-wellness/staying-healthy/first-aid/ankle-sprains-healing-and-preventing-injury.printerview.all.html. Accessed November 21, 2014.

The combination of rest, compression, and pain relief can help support the body's natural healing process, and prevent further aggravation of the ankle injury.

Grade 3 Ankle Sprains and Strains

Grade 3 sprains and strains are usually unstable and require longer healing. The following treatment protocol may be used:

Casting. In addition to rest and elevation, the first phase of healing usually involves casting or bracing of the foot, ankle, and lower leg. A traditional plaster cast may be used, or a commercial air cast. Many patients will require crutches, though some may be issued a walkable cast-brace device for all or part of the recovery period.

Rehabilitation. Patients may need to undergo a series of rehabilitation treatments, such as electrical stimulation and ultrasound, as well as strengthening exercises to help decrease pain and support the development of new tissue. Isometric strengthening exercises that promote proprioception (body/joint position awareness) are especially important in Grade 3 sprains and strains to help reduce the chance of re-injury. Therapeutic exercises may be land-based or water-based, with water-based exercises usually reserved for those with severe injury.

See Simple Exercises to Restore Proprioception and Advanced Exercises to Restore Proprioception

Surgery. In severe and/or chronic sprains and strains that do not respond to first-line treatment or rehabilitation, one or more types of surgery may be required:

• Surgery may be arthroscopic, in which the surgeon looks inside the ankle joint with a special camera to determine if any loose bone fragments may be interfering with the healing process. Arthroscopy can also be used to determine if a portion of the injured ligament, muscle, or tendon has become caught within the joint capsule.
• Surgery may be reconstructive, in which the surgeon repairs torn ligaments, muscles, or tendons with stitches or other types of sutures. The surgeon may also transplant tissue from other parts of the patient's foot and ankle to aid in the reconstruction.
• Orthopedic surgeons generally perform ankle surgery. Orthopedic surgeons may also be fellowship trained in the exclusive practice of foot and ankle surgery.

Patients who require surgery to treat their ankle sprains and strains will require additional recovery time and physical therapy, which can range from weeks to months. Some patients with severe or chronic sprains may not be able to return to their prior level of activity. Surgery to treat ankle sprains and strains is quite rare.

Patients with extremely painful Grade 3 sprains or those recovering from surgery may also receive prescription pain medication, such as Tylenol-3 or other opioid narcotic pain medications, to address acute, severe pain.