Ankle Sprain is one of the most common musculoskeletal injuries that occur when ligaments of the ankle joint are overstretched or torn. Most commonly, ankle sprain involves injuries to the lateral ligament (85%) when the ankle is rolled, twisted, or turned in an awkward way. Ligaments are tough bands of tissue that support the stabilization of joints, preventing excessive movements in one direction. The ankle is sprained when these ligaments are forced beyond their maximum range of motion.

Research says that ankle sprains are the second most common type of injury among athletes and sports populations after knee injuries. This systematic review discovered that ankle sprains were predominantly high in team sports and court games, including basketball, volleyball, or soccer.  A meta-analysis by Doherty et al. reported that indoor sports i.e., basketball carry the highest risk of ankle sprains with an incidence of 7 in 1000 exposures. Moreover, severe ankle sprains are associated with higher recurrence rates, greater than 70%, in these players.

Management of Ankle Sprain 

PRICE Protocol for Ankle Sprain Management

PRICE protocol is an updated version of the traditional RICE protocol with an added “Protection” component. Experts recommend patients experiencing any acute injury, such as ankle sprains, follow PRICE protocol to prevent further damage, particularly in the first 24-72 hours. This protocol includes the following components:

• Protection: It refers to preventing further injury by limiting weight-bearing on ankles by using crutches or simply immobilizing the injured area for a particular time.

• Rest: Rest is crucial to aid the body’s healing process. Sports physiologists recommend “relative rest” that is not so restrictive as to limit the recovery. Some movements at the injured joint are allowed; however, a person should prevent strain or excessive stress on that limb.

• Ice: Cold treatments, known as cryotherapy, have long been known for reducing pain and swelling. Applying ice over the injured area followed by acute sprain is a convenient and most common way to treat inflammation. However, ice should not be applied for more than 10-15 minutes at a time, with a 1-2 hour break, and repeat the 10-15 minutes icing sessions.

• Compression: It refers to applying external force in the form of an elastic bandage to compress the injured area. It minimizes swelling and often provides support. It is important to apply a medium amount of tension while wrapping an elastic bandage to prevent pressure necrosis of soft tissues.

• Elevation: The injured limb should be elevated above the heart level to drain pooled fluid from the injured area. It alleviates swelling, reduces pain, and speeds up the recovery process. It’s recommended to elevate the injured ankle on extra pillows during most waking hours in the initial 24-48h period.

POLICE Protocol for Ankle Sprain Management

The POLICE protocol is the modern first-aid approach to managing musculoskeletal injuries like ankle sprains. It is far more beneficial and effective than traditional RICE and PRICE protocols. It has the following components:

• Protection: It refers to restricting the range of motions at injured joints but doesn’t imply complete immobilization. It is recommended that several aids be utilized to facilitate gentle movements and prevent strain and stretch on the injured ankle. 

• Optimal Loading: It is generally required to stimulate the body’s natural healing process by utilizing mechanotherapy interventions. It involves several manual techniques such as light movements and strengthening exercises to build up muscles and alleviate edema.

• Ice: It refers to applying cold therapy or ice to an injured ankle in 10-15-minute cycles to reduce pain and swelling.

• Compression: Compression means applying external pressure in terms of elastic bands to limit swelling.

• Elevation: It is important to elevate the affected limb above the level of the heart, as discussed in the PRICE protocol above.