Rest is recommended to prevent loading on the affected joint.
Ice therapy should be done for 3-7 days after an injury for pain and swelling reduction.
Compression bandaging like elastic bandaging is applied to reduce swelling and improve healing.
The affected limb is elevated up to 15-25 cm above the level of the heart to assist with lymphatic drainage.
An ankle brace should be used for a minimum of 6 months to protect the damaged tissues. A semi-rigid brace or lace-up brace is recommended for individuals with a prior history of ankle sprains.
Kinesio taping helps to provide sufficient mechanical support for an unstable joint.
Transcutaneous Electrical stimulation:
Transcutaneous Electrical stimulation is found to be effective to decrease swelling and pain.
Laser therapy is also used to reduce pain and swelling.
Therapeutic ultrasound decreases pain, and edema improves function and helps the patient to return to daily activities.
Manual therapy includes soft tissue massage, lymphatic drainage, anterior to posterior talocrural glides, and talocrural distraction in the neutral position. Manual therapy helps in pain reduction, reduces stiffness, and causes functional recovery.
Range of motion exercises:
Simple range of motion exercises can be done to improve joint mobility. Even passive range of motion for dorsiflexion can be performed in both positions of weight-bearing or non-weight-bearing.
Stretching exercises can be started with an open-chain exercise in all planes, dorsiflexion stretch with upper extremity assistance, and further progress to closed chain exercises. Heel cord stretching should be initiated as soon as possible.
Strengthening exercises are started immediately for grade I and II sprains, whereas for grade III sprain is postponed, inversion and eversion of the ankle should be minimized. The exercises are started with isometrics in frontal and sagittal planes, progress to isotonic resistive exercises with weights, elastic bands, or manual resistance, add movement in all planes, slow movements performed within pain limits, and high repetitions e.g 23 sets with 10 repetitions.
Proprioceptive Neuromuscular Facilitation:
Proprioceptive neuromuscular facilitation (PNF) exercises cause a significant improvement in ankle function and pain-free higher activity levels.
Balance training is recommended during all stages of rehabilitation for example standing exercises initiated on one leg should be done and progressed towards maintaining balance on an unstable surface like a wobble board with both legs and then the injured foot and with the slow removal of hands support.
Plyometric training involves high-intensity exercises such as include jumping, running and cutting drills, etc.