Ankle sprains in young athletes Part 2: How to manage and prevent

December 1, 2005

Effective rehabilitation is the key to avoiding long-term problems and recurrent injury. Here's what needs to be done in the immediate aftermath of the injury and over the weeks and months that follow to promote full recovery.

DR. PATEL is professor of pediatrics and human development, Michigan State University College of Human Medicine and Kalamazoo Center for Medical Studies, Kalamazoo.

MS. JANISKI is a graduate assistant in the athletic training program, sports medicine clinic, Western Michigan University, Kalamazoo.

The authors have nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

Immediate intervention

Applying ice for the first 48 to 72 hours (at least 48 hours) decreases edema and pain. The patient should apply bags of crushed ice and elevate the ankle for 20 to 30 minutes at a time with a minimum rest period of one or two hours between sessions. Elevating the affected limb above the level of the heart increases venous return and helps eliminate excess fluid and debris from the area. After the first 48 to 72 hours, immersing the ankle in cold water in a whirlpool or bath and simple range of motion (ROM) exercises are recommended. Because of the importance of elevation in the immediate care of an ankle sprain, the patient should wait at least 48 hours before integrating cold water immersion treatments into the rehabilitation program.

Contrast baths-immersing the affected limb alternately in cold and warm water at a ratio of one minute cold immersion to three minutes warm immersion-can also be introduced at this time. Contrast baths are thought to stimulate a pumping mechanism in the circulatory system that helps decrease edema.

Compression by means of open-basket-weave ankle taping or a simple elastic wrap increases comfort and limits edema. Adding a felt horseshoe-shaped pad around the lateral malleolus and extending superiorly toward the knee enhances the effectiveness of the elastic wrap.

Planning treatment

Once immediate care (the PRICE steps) has been initiated, the athlete should be seen again in three to seven days. The severity of the sprain can be better assessed at this time because swelling, muscle spasms, and pain have decreased.

Mild, or grade 1, sprains may not need specific rehabilitation beyond increasing range-of-motion exercises followed by strengthening exercises. Younger (prepubertal) children with mild sprains who are playing sports for fun and recreation may do well with a short period of rest followed by simple range of motion and strengthening exercises.