How to treat an ankle sprain

Ankle sprains and inversion injuries (twisting your ankle) are the most common injury to occur in any sport. However, they are often poorly diagnosed and as a result can go untreated.
It is very common for people to attend A&E after an ankle injury, however if there is no fracture then they can often be overlooked. Nevertheless the management of a ligament sprain should be as important as the management of a fracture.

Whether you are a premiership footballer or weekend warrior playing for your pub team, the treatment should be the same. When you sprain a ligament a series of events occur. The injury will instantly bleed, resulting in pain and swelling (and later, visible bruising). At first glance, a ligament injury can look as bad as a break. The first step is to rule out a fracture, so a trip to A&E is highly recommended.

Once a fracture has been ruled it, follow these steps.

1. The important thing at this stage is to prevent any further injury. ICE is a fantastic tool in reducing secondary injury, and it’s available to nearly everyone! It helps reduce the toxins that are in the swelling and it reduces pain. The ice should be applied with some COMPRESSION, this will help the pumping effect of the blood vessels in the leg. A recommended strategy is 10 minutes every 2 hours.

2. Take the weight off the foot to help it REST. Weight bearing in the early stages can increase stress through the ligament, which will result in more swelling and possible re-injury. Obtain a pair of crutches from A&E or from a local mobility shop. Although the foot is injured, this should not be an excuse for 2 weeks on the sofa, there are always other exercises you can do to maintain fitness levels throughout the rest of the body. Some people are aware of the acronym R.I.C.E (Rest, Ice, Compression, Elevation). This treatment is starting to be replaced by P.O.L.I.C.E (Protection, Optimal Loading, Ice, Compression, Elevation) which discourages people from completely resting and de-conditioning. See a physiotherapist for advice on optimal loading, as this will differ depending on the degree of injury.

3. ELEVATE the foot so that it is above the level of your hip. This will help the swelling to drain back towards the centre of the body where it can be reabsorbed. Because the foot will be resting, the calf muscle will not be pumping blood and oedema (swelling) back up the leg, so the elevation phase is crucial to help reduce chronic problems.

4. There is an open debate about the use of anti-inflammatories with acute injuries – but the evidence suggests that for the first 48 hours, it is better to not take any. Within the swelling is a rich supply of nutrition which will help to stop the bleeding of the torn tissue and help repair the injury. For this reason, anti-inflammatories should be avoided for the first 48 hours. Ice and elevation will help you more at this stage. Paracetamol will help with pain relief at this stage.

5. Ankle ligaments are vital for balance and poor rehabilitation leads to re-injury. A lot of the rehabilitation is patient-lead, but the correct exercises are crucial. Book an appointment to see a physiotherapist – ideally as soon as possible as quick intervention will increase recovery times. Leaving it for 6 months will probably result in prolonged treatment and slower results.

Page last reviewed on 28/06/2013