National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes

NATA's ankle sprain statement gives athletic trainers recommendations for assessing, treating, returning to play and preventing ankle sprains in athletes, including high (syndesmotic) sprains and chronic ankle instability.

For assessment it endorses the Ottawa Ankle Rules to decide who needs an x-ray, notes that ligament stress tests are more accurate a few days after injury than right away, and rates MRI as reliable for ligament tears. For treatment, it favors functional rehabilitation over immobilization for mild and moderate sprains, while severe (grade III) sprains should be immobilized in a rigid brace or cast for at least 10 days first. It supports anti-inflammatory medication, cold, compression and elevation early on, balance training throughout rehabilitation, and joint mobilization to restore ankle dorsiflexion, and advises against heat in the early phases.

Return to play should weigh the athlete's own sense of function and functional testing, with the injured limb reaching at least 80% of the other. Athletes with a previous sprain should be taped or braced for practices and games, and teams should run a balance and neuromuscular training program of at least 3 months to prevent sprains.