Ankle > Ankle Sprain > Treatments

   R.I.C.E. and Physical Therapy

Home Recovery

Physicians generally recommend that you avoid sports and everyday physical activities until your sprained ankle has healed. Crutches are usually prescribed for the one to three weeks after a moderate or severe sprain. Household tasks that require you to be on your feet may be difficult for a few weeks after a moderate to severe ankle sprain. It can be helpful to arrange for someone to visit you to help with any physical chores. In general, you should continue R.I.C.E. treatment as instructed by your doctor until symptoms go away. After 72 hours, your physician may prescribe heat therapy. Only apply heat if the sprain has healed, which may take up to three months. Heat draws blood to the skin around the ankle, which may increase swelling and internal bleeding if used too soon after a sprain. Many heating treatments are available and physicians generally suggest a specific heat therapy at their discretion. Heating options include heat lamps, hot showers, heating pads, heat ointments, and whirlpool or bath treatments. Massage also may be used to soothe muscle pain. However, massaging an injured ankle can disrupt the healing process and damage injured ligaments right after an injury. Your physician will decide when it is safe to begin ankle massage. Proper nutrition may also help heal an ankle sprain. Your physician may suggest taking vitamin supplements that contain vitamin C, vitamin A, vitamin E, and selenium. However, research has not yet proven how important nutrition is for healing nor which vitamins, minerals, or supplements are the most effective. Your physician will either suggest physical therapy that can be done at home or refer you to a physical therapist within a week after the sprain to help you restore range of motion in your ankle.

Physical therapy usually is prescribed to help ligaments heal after most moderate and severe ankle sprains. As soon as possible after the sprain, your physician may refer you to a physical therapist to begin early motion, which helps circulate fluid out of the ankle. Early motion consists of simple up and down flexion and extension, and progresses to small circles or drawing the alphabet on the floor with your toes. Therapists also may use electrical stimulation to control swelling. Knowing when to start more vigorous rehabilitation exercises is difficult and should be decided by your physician. Physicians generally recommend that you avoid bearing weight and walking in pain after an ankle sprain. Patients tend to heal better in the long-term if they start rehab slowly, instead of rushing to begin painful exercises on an ankle that has not yet healed. When swelling and pain have gone away and you feel comfortable without supportive wrapping, you usually start an exercise program to strengthen all the muscles around your ankle. Elastic bands are often used to provide resistance as you move your ankle in different directions. The amount of resistance increases over time as you regain strength in the muscles around the ankle. You may help your ankle feel better by icing it for 10 minutes both before and after rehab exercises. It is particularly important to strengthen the peroneal muscles, located on the outside of your lower leg around your small lower leg bone (fibula). The peroneals help keep your ankle from turning inward. Arthritis may result from repeated ankle sprains, which can hinder your ability to return to your previous activity level. People with arthritis or who suffer repeated ankle sprains may need to spend extra time in rehab and perform a more elaborate training program. The final steps of rehab help increase coordination, and may include balance beam exercises and running in a figure-eight pattern. When the injured ankle is about 90 to 100 percent as strong as the uninjured ankle, you may be ready to begin returning to activities. Most patients can rehabilitate their ankles with less than three months of physical therapy and return to activities at full strength.

Prevention

To prevent the recurrence of ankle sprains, you should make the stretching and strengthening you learned in physical therapy part of your regular exercise routine. A strong and flexible ankle may be better able to withstand any abnormal positions and strain that occur during sports and recreational activities. Before activities, remember to warm up your ankle muscles by stretching in all directions. Tight ankle muscles and ligaments may be more apt to pull or tear. Replace athletic shoes when the padding or the tread wears out. Avoid participating in activities in old, worn-out shoes because they do not provide good padding or side-to-side support.

In general, you should try to provide extra support to your ankle for at least 12 months after a severe sprain, possibly longer. Taping is a good preventive measure if it is done immediately before participating in the sport and if the person doing the taping is trained in proper techniques. Ankles are usually taped all the way from the midfoot to the lower calf. Physicians generally do not advocate the use of braces for people who have not had ankle injuries. But for people who have had recurrent injuries and those in the early post-injury period, braces may be useful to enhance recovery and prevent further injury. Neoprene sleeves simply provide compression and other lace-up types of braces provide more support using metal or plastic strips on the sides of your ankle.

DEALING WITH PAIN

A small amount of pain is normal during activities, but if you feel so much pain in your ankle to warrant taking a painkiller before an activity, you should consider cutting back or stopping. If you experience significant pain in your foot or ankle, do not continue to run on a sore ankle. Pain after rehabilitation could be a sign that you have excess scar tissue, loose fragments of bone or cartilage that were not seen on the initial X-rays, or other minor foot and ankle injuries that need proper treatment before you can return to activities.

Non-surgical treatment can usually heal ankle sprains. Physicians typically prescribe a combination of R.I.C.E. (rest, ice, compression, and elevation), medication, and physical therapy. Immediately after you suffer an ankle sprain, you may want to follow the first-aid routine known as R.I.C.E.:

   Rest – Your doctor will likely suggest that you refrain from sports activities, and lie or sit down for a few hours at a time every day until your ankle sprain heals. Just the weight of your body puts pressure on the ankle, lengthening recovery time.

   Ice – initially, your doctor will likely recommend applying ice packs to the ankle for about 20 minutes every three or four hours. You will probably need to do this for two or three days or until the pain subsides, and you may need to do it after exercise or activities. One effective way to apply ice is to use a bag of frozen vegetables, which molds easily to the shape of the injured area. It won’t leak and it can be re-used. (Warning: Do not eat the contents after thawing and re-freezing.)

   Compression – Doctors often recommend bracing or wrapping your ankle. There are many different types of bandages, braces, and splints that your doctor may choose to prescribe. A wrap is often effective but a removable air cast is usually the most secure way to stabilize your ankle.

   Elevation – Raising the ankle to a level higher than the heart helps reduce swelling. Try to prop your ankle up on a couple of pillows when lying down or sleeping.

You may be prescribed pain medication as needed, depending on the severity of your ankle sprain. For minor sprains, most patients receive adequate pain relief from non-prescription painkillers like aspirin or ibuprofen. More severe sprains may require narcotic painkillers or, in rare cases, an injection of painkiller directly into the ankle. Your physician will decide when it is appropriate to visit a physical therapist to begin stretching and strengthening exercises for the ankle. Most patients begin physical therapy within a week of an ankle sprain. The time it takes to heal ankle sprains is highly variable:

   Mild sprains typically heal in two to 10 days.

   Moderate sprains may need ten days to six weeks to heal.

   Severe sprains can take between six weeks and four months to heal.

Your physician will probably prescribe a few regular check-up visits if you have a moderate or severe sprain, but most of the treatment can be done at home.