Sprains

Early Management Aims during the first 72 hours

• Reduce tissue temperature, pain and swelling
• Reduce metabolic demands of the tissue
• Prevent further injury
• Promote collagen growth and realignment
• Maintain cardiorespiratory and musculoskeletal activity

Acute Inflammatory Stage - PRICE

Protection - Prevents worsening of injury
Rest - Avoids pain from movement. Complete immobilisation is not indicated to prevent significant loss of ROM. Even for grade III injuries a functional splintage is strongly suggested.
Ice - Reduces pain. Application of ice should be for 10-30 minutes wrapped in cloth to avoid cold injury. Repetition can be as frequent as required, providing the affected part is fully warmed back to body temperature.
Compression - Provides comfort by limiting movement and reducing swelling, although should be applied so as to not reduce blood flow. 
Elevation - Helps to reduce swelling, especially with the affected part above heart level.

Sub-Acute Proliferation & Remodelling Stage

Active rehabilitation:

• Electrotherapy (for example ultrasound for collagen synthesis)
• Manual therapy (for joint pain)
• Restore mobility and prevent joint deformity
• Progressive loading to begin to restore strength and improve joint stability

In the remodelling stage:

• Deep tissue frictions
• Electrotherapy (for example ultrasound to enhance tensile strength and scare mobility)
• Manual therapy (for joint stiffness)
• Progressive mobilisation and strengthening exercises