Treatment administered in the first 24 hours is the most important determinant of long-term recovery from an acute ankle sprain. Chronic or recurrent ankle sprains also need physiotherapy rehabilitation to achieve stability and should be treated immediately by a physiotherapist to improve stability and decrease pain.
The most common type of ankle sprain is due to excessive inversion and plantarflexion, called an “inversion sprain”, and stretches or tears the lateral and anterior ankle ligaments, can damage the retinaculum and often impinges the medial ankle structures. Egg-shaped swelling appears on the outside of the ankle. A grade one injury is caused by mild over-stretching with less than 10% of ligament fibres torn. A grade two injury involves considerable tearing of the ligament fibres and a grade three injury is a complete rupture or avulsion of a ligament.
Treatment within the first 24-72 hours should be aimed at preventing further damage and reducing swelling by immobilising the ankle in an everted and dorsiflexed position. This can be effectively achieved by rigid strapping with compression that can be loosened by the patient if the ankle continues to swell. Keeping the ankle elevated above the level of the heart and applying icepacks to the ankle for 20-30 minutes every 2 hours is effective at reducing pain and swelling also. If the injury is a grade 2 or 3 sprain, the patient should use crutches for the first 48-72 hours and partial weight bearing should commence after this time to assist with removal of oedema. Early but gentle active and passive mobilisations to the subtalar and talo-crural joints have been shown to recover range of movement safely and effectively. Treatment in the sub-acute phase consists primarily of exercises and manual therapy to regain proprioception, strength and range of movement.
Patients who have had early immobilisation and referral to Physiotherapy after a grade 1-2 lateral ankle sprains have demonstrated a better overall outcome and an earlier return to function.
A study done in 2014 states that a first-time ankle sprain injury has a 95% probability to return to sport within 10 days. However, patients who return to sport too early risk re-injury. To decrease this risk, patients require an extensive rehabilitation program aiming to resolve residual impaired of strength, static and dynamic balance, range of motion and landing strategies. It takes 28 days for the ligament to finish healing. However, it can take 6 weeks to 3 months for significant improvements to become apparent in mechanical stability.