Exercise for the Treatment of Ankle Sprain: A Review of Clinical Effectiveness and Guidelines [Internet]

Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Apr 3.


In Canada, 35% of injuries are related to sport or exercise. Ankle injuries (sprain or strain) are among the most common types of injury (51%) presenting to the primary care offices and emergency departments. There are three types of ankle sprain, the location of which is determined by the mechanism of injury: lateral ankle sprain (most common), medial ankle sprain, and syndesmotic sprain (high ankle sprain). Ankle sprain is classified based on clinical signs and functional loss, as follows: grade 1 (mild stretching of a ligament), grade 2 (more severe injury involving incomplete tear of a ligament), and grade 3 (complete tear of a ligament).

The immediate goal for treatment of ankle sprain is to reduce pain and swelling. The RICE (rest, ice, compression, elevation) approach has been commonly used in the first two to three days following injury, although evidence on the effectiveness of RICE alone is still lacking. Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce pain. However, the use of NSAIDs may delay the natural healing process due to their inflammatory suppressed mechanism. Other modes of non-pharmacological treatment of ankle sprain, depending on the severity of the injury, include exercise, immobilization, manual mobilization and rehabilitation. Early mobilization through exercise right after lateral ankle sprain is often the integral component of the treatment. However, this is in direct contrast to the RICE method, and the clinical effectiveness of exercise remains controversial, despite the existence of multiple exercise-based physiotherapy programs with different content and parameters for treatment of ankle sprain.

The aim of this report is to review the evidence regarding the clinical effectiveness of exercise for the treatment of individuals with ankle sprain. This report also aims to review the evidence-based guidelines regarding the use of non-pharmacological interventions for the treatment of individuals with ankle sprain.

Publication types

  • Review

Grants and funding

Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.