Lateral ankle sprain: what the guidelines recommend, and where cryocompression fits
Lateral ankle sprain: what the guidelines recommend, and where cryocompression fits
A common injury, with an uncommonly high rate of recurrence
The lateral ankle sprain is one of the most frequent musculoskeletal presentations, and one of the most likely to be treated casually. The clinical stake is not the acute episode itself, it is what follows: residual instability and recurrence. This is where the choices made in the first two weeks matter.
Two sources are useful for framing practice: the updated evidence based guideline published in the British Journal of Sports Medicine, and a systematic review that compared seven clinical practice guidelines and extracted the recommendations supported by enough evidence to be applied.1,2
What the guidelines actually recommend
The guideline states that the severity of ligament damage is assessed most reliably by a delayed physical examination, four to five days after the trauma, rather than immediately. After a correct diagnosis, the patient with an acute lateral ligament rupture benefits most from tape or a brace combined with an exercise programme; a short period of immobilisation may help relieve pain and swelling, but it is not the treatment itself.1
The systematic review of guidelines converges on six recommendations with sufficient evidence: the Ottawa rules for imaging decisions, manual therapy, cryotherapy, functional supports, early ambulation, short term non-steroidal anti-inflammatory drugs, and rehabilitation.2
Supervised exercise1
Preferred over passive modalities, because it stimulates the recovery of functional joint stability.
Functional support1
Tape or brace combined with exercise gives the best outcome after acute lateral ligament rupture.
Anti-inflammatories1
May reduce pain and swelling, but use is not without complications and they may suppress the natural healing process.
Prevention1
Ankle braces should be considered an efficacious option to prevent recurrent sprains.
Cold and compression: what is supported, and what is extrapolated
Cryotherapy is listed among the recommendations supported by enough evidence to be applied in the management of ankle sprain.2 That is the honest statement of the evidence: cold has a place in the acute phase, mainly on pain and swelling.
The randomised evidence comparing cold combined with dynamic compression against cold alone comes from a different setting, total knee arthroplasty, where the combination produced a greater reduction of effusion and of pain during activity at day 21.3 The mechanism is not joint specific, and the ankle is a segment where oedema is a major limiting factor, but transposing that trial to the ankle remains an extrapolation and should be presented as such to patients.
The practical point that both sources agree on: cold and compression manage symptoms so that the patient can start loading and exercising sooner. They do not replace the exercise programme, which is what restores functional stability.1,2
A workable protocol for the first two weeks
Days 0 to 2
Protect and control the swelling. Cold and compression sessions, elevation, early weight bearing as tolerated. Imaging decided by the Ottawa rules.2
Days 3 to 5
Delayed physical examination to grade the ligament damage reliably, then confirm the plan.1
First two weeks
Functional support with tape or brace, and the start of a supervised exercise programme rather than rest alone.1
Follow up
Progress to proprioceptive and strengthening work; consider a brace for return to sport, since it is an efficacious option against recurrence.1
Frequently asked questions
Should the ankle be immobilised?
Only briefly, and to relieve pain and swelling. The guideline is explicit that the benefit comes from tape or a brace combined with an exercise programme.1
Are NSAIDs (non-steroidal anti-inflammatory drugs) recommended?
They may reduce pain and swelling, and short term use appears among the supported recommendations, but the guideline also warns that they may suppress the natural healing process.1,2
When is surgery considered?
It should be reserved for cases that do not respond to a thorough, comprehensive exercise based treatment.1
Where does cryocompression fit?
In the acute phase, to control pain and oedema so that loading and exercise can start earlier. It is an adjunct to the exercise programme, not a replacement.
Game Ready at home: how Kolde rental works
Kolde rents the Game Ready® cryocompression system and delivers it to the patient at home, with the anatomical wrap matching the operated area. The prescriber sets the protocol, and the patient follows it between rehabilitation sessions. Delivery, installation and collection are handled by our team, so nothing is left for the patient or the clinic to organise.
References
- Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine. 2018. PMID 29514819.
- Ruiz-Sánchez FJ, Ruiz-Muñoz M, Martín-Martín J, Coheña-Jimenez M, Perez-Belloso AJ, Romero-Galisteo RP, Gónzalez-Sánchez M. Management and treatment of ankle sprain according to clinical practice guidelines: a PRISMA systematic review. Medicine (Baltimore). 2022. PMID 36281183.
- Quesnot A, Mouchel S, Ben Salah S, Baranes I, Martinez L, Billuart F. Randomized controlled trial of compressive cryotherapy versus standard cryotherapy after total knee arthroplasty. BMC Musculoskeletal Disorders. 2024. PMID 38419032.
This article is for information only. It does not replace the advice of a surgeon, doctor or physiotherapist, and it does not constitute a treatment protocol. Indications, contraindications and session parameters remain the responsibility of the prescribing clinician.