Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is a sprain?

A sprain is a stretched or torn ligament. Ligaments connect one bone to another bone at a joint and help keep the bones from moving out of place. The most common site of sprains is the ankle. Ligaments of the ankle joint are shown below.

How are ankle sprains diagnosed?

Signs of an ankle sprain are swelling, pain, bruising and trouble moving the ankle after the injury. Your doctor will usually be able to tell if you have a sprain by asking you some questions about how the injury occurred and by examining your ankle. An x-ray may be needed if your doctor thinks you might have a broken bone.

How can ankle sprains be treated?

Many doctors suggest using the RICE approach—Rest, Ice, Compression, Elevation—for treating ankle sprains.

RICE approach to treating ankle sprains

	Rest- you may need to rest your ankle, either completely or partly, depending on how serious your sprain is. Use crutches for as long as it hurts you to stand on your foot.
	Ice- Using ice packs, ice slush baths or ice massages can decrease the swelling, pain, bruising and muscle spasms. Keep using ice for up to three days after the injury. Don’t use heat for at least three days.
	Compression- Wrapping your ankle may be the best way to avoid swelling and bruising. You’ll probably need to keep your ankle wrapped for the first day or two after the injury and perhaps for up to a week or more.
	Elevation- Raising your ankle to or above the level of your heart will help prevent the swelling from getting worse and will help reduce bruising. Try to keep your ankle elevated for about two to three hours a day if possible.

Will I need to wear a cast?

This will depend on how serious your sprain is, if you have other ankle injuries and how your doctor thinks your sprain should be treated.

How long before I can use my ankle?

This also depends on how serious your sprain is. If you’re not wearing a cast, your doctor may suggest that you start trying to use your ankle again fairly soon - from one to three days after your injury.

Special exercises are sometimes needed to regain strength and to help reduce the chance of ongoing problems. Your ankle may need to be supported with taping or bracing to help protect it from re-injury.

What about medicine?

If you feel like you need some medicine to ease the pain, try ibuprofen (some examples are Advil, Medipren, Motrin IB), ASA (an example is Aspirin) acetaminophen (an example is Tylenol).

What is the best way to use ice?

Putting ice on your ankle can be very helpful, but you also need to be careful. The cold can damage nerves if the ice is left in place too long.

Ice can be left on your ankle for up to 20 minutes at a time. When your skin feels numb, it’s time to remove the ice.

Use ice treatments every two to four hours for the first three days after your injury. Ice treatments can consist of ice packs, ice slush baths or ice massages.

Ice packs can be very easy to use. Partly fill a plastic bag with crushed ice. You may also use a small bag of frozen vegetables, such as peas. Wrap a thin, wet cloth around your injury. Place the ice pack over this and then wrap an elastic bandage around the ice pack to hold it still.

For ice slush baths, fill a large bucket with water and ice. Place your ankle in the bucket until the skin gets numb. Don’t leave your foot in too long.

Ice massages can work well for small areas. Freeze water in 4- to 8-oz disposable drinking cups. Tear the top part of the cup away from the ice. Hold the covered end and slowly rub the ice over the sprained area with a circular motion. Don’t hold the ice on one spot for more than 30 seconds.

Will I need surgery?

Not unless your ankle sprain is severe. Some doctors think surgery should be performed to repair ligaments that have been torn completely. Others think these injures can heal on their own by using a cast or brace. Competitive athletes should ask their doctor about surgery for any severe sprains.

What about wrapping a sprained ankle?

Wrapping an ankle is good for comfort. To apply a bandage and adhesive tape, consult your doctor. The ankle shouldn’t be wrapped so tightly that the blood flow is cut off. Your doctor may recommend physiotherapy.

What about sports?

If you’re an athlete, you’ll probably be able to return to your sport in one to 16 weeks, depending on how serious you injury is and what sport you’re involved in. When participating in sports, you’ll probably need to keep your ankle braced or wrapped for support and protection. Bicycling, swimming or even running are usually okay to return to right away. But you’ll still need to avoid pivoting and twisting movement for two to three weeks. Volleyball, basketball, football and racquetball are associated with the highest rate of ankle sprains.

How can I prevent reinjuring myself?

It may take weeks or even months for the ligaments to heal completely. When your doctor feels you’re ready to exercise again, you can help prevent further sprains and setbacks by wearing a semi-rigid ankle brace.

Special wraps that use hook and loop fasteners (such as VELCRO) or air-filled or laced braces may also help prevent reinjury. Wearing high-top tennis shoes may help prevent ankle sprains if your shoes are laced snugly and if you also tape your ankle with a wide, nonelastic adhesive tape. Elastic tape or braces may not be helpful because the elastic goes too much around the joint.

Once your sprain has completely healed, a program of ankle exercises will also help prevent injuries by making muscles that move the ankle stronger, providing extra protection to the ligaments. Ask your doctor to recommend an exercise program.

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.