What is the recommended initial management protocol for an acute ankle sprain in adults?

The recommended initial management protocol for an acute ankle sprain in adults involves a combination of early functional support, pain management, and gradual mobilization to promote recovery and prevent recurrence. Initially, the use of functional support such as an ankle brace or taping for 4–6 weeks is preferred over rigid immobilization, as it allows protected loading of the injured tissues and is more effective than compression bandages alone ¹. Early mobilization is strongly supported to improve pain, swelling, and function, with moderate evidence endorsing exercise and manual therapy techniques to aid recovery ¹.

For pain relief, paracetamol is recommended as an effective first-line analgesic, with non-steroidal anti-inflammatory drugs (NSAIDs) considered as an option except in frail or older adults, where caution is advised ¹. Paracetamol has been found to be as effective as NSAIDs for pain, swelling, and range of movement in ankle sprains (van den Bekerom et al., 2012). Self-care advice includes gradual weight-bearing as tolerated, use of appropriate footwear, and avoiding activities that cause pain or fatigue ¹.

Referral to physiotherapy may be arranged to consider supervised exercise programs and external support, especially in cases with slower recovery or recurrent sprains, although evidence on the added benefit of supervised physiotherapy over usual care is mixed ¹. Surgical intervention is generally reserved for persistent symptoms or chronic instability after comprehensive conservative treatment ¹. Imaging such as MRI is not routinely required but may be considered if symptoms persist or worsen, to exclude more severe injuries ¹.