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Management of tendon or ligament sprain with swelling

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acute ankle sprain management swelling guideline PEACE LOVE Ottawa rules

For a mild tendon strain or ligament sprain with swelling:
  1. Protect it for 24-72 hours
    Stop the activity that caused pain. Use a brace, supportive shoe, splint, or crutches if walking/use is painful. Avoid complete immobilization for many days unless a clinician advises it.
  2. Control swelling
    • Compression: Elastic bandage or sleeve, snug but not tight. Loosen it if there is numbness, tingling, increasing pain, coldness, or color change beyond the wrap.
    • Elevation: Raise the injured part above heart level when resting.
    • Cold: Apply a wrapped cold pack for 15-20 minutes at a time, several times a day during the first 2-3 days. Never place ice directly on skin. For ankle sprains, cryotherapy can reduce pain and aid early recovery. AAFP review
  3. Pain relief
    • Paracetamol/acetaminophen is an option if safe for you.
    • An anti-inflammatory such as ibuprofen or naproxen can help pain, but avoid it or ask a clinician/pharmacist first if you have kidney disease, stomach ulcers or bleeding, take blood thinners, are pregnant, or have relevant heart problems.
  4. Begin gentle movement early Once severe pain settles, gently move the joint through a comfortable range several times daily. Then progressively add stretching, strengthening, and balance exercises. Early protected mobilization is generally better than prolonged rest for uncomplicated ankle sprains. AAFP guidance
  5. Return gradually Resume sport or heavy activity only when swelling is minimal, normal movement and strength have returned, and you can walk, hop, grip, or perform the relevant task without pain or instability. A brace or taping may help during the initial return.
Seek urgent assessment today if there is deformity; inability to take four steps or use the limb; severe or worsening swelling/pain; marked bony tenderness; numbness, coolness, or blue/pale skin; an open wound; fever/redness; a pop followed by major weakness; or suspected tendon rupture, such as inability to push off after an Achilles injury. For an ankle/foot injury, inability to bear weight or tenderness directly over the ankle bones, navicular, or base of the fifth metatarsal can warrant an X-ray under the Ottawa ankle rules. Ottawa rule summary
Arrange a clinician or physiotherapist review if symptoms are not clearly improving within 5-7 days, swelling persists, the joint repeatedly gives way, or you cannot return to usual activity within a few weeks.
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