Clinical guideline for ankle sprains: judge severity at 4–5 days, treat with a brace or tape plus an exercise programme, prefer supervised exercise to passive treatments, and be careful with NSAIDs
Key Findings
Severity of ligament damage is assessed most reliably by a delayed physical examination, 4–5 days after the injury.
A short period of immobilisation may help pain and swelling, but a person with an acute lateral ligament rupture benefits most from tape or a brace combined with an exercise programme.
Supervised exercise-based programmes are preferred over passive modalities because they stimulate recovery of functional joint stability.
NSAIDs may be used for pain and swelling, but with care: use is not without complications and they may suppress the natural healing process.
Ankle braces should be considered an efficacious option for preventing recurrent sprains.
Practical Application
How bad a sprain is cannot be told on day one. If it is not clearly improving by day 4–5, that is the moment for a clinician's examination, not for more waiting.
A brace or tape for the return to running, plus the exercise programme, is the default — and the brace stays for a while afterwards, because recurrence is the common outcome.
Do not suggest anti-inflammatories as routine; if the athlete asks, relay the guideline's caution and leave the decision to them and their doctor.
Limitations
No return-to-running criteria in the abstract; the strength of evidence behind each statement was not seen (abstract only was read).