For a sprained ankle, the immediate priorities are ice, a compression wrap, and elevation. These three things reduce swelling and pain in the critical first 72 hours. Beyond that initial window, you’ll shift toward gentle movement, supportive braces, and over-the-counter pain relief to speed recovery.
Ice: How Long and How Often
Apply ice as soon as possible after the injury. The most studied approach is 20 minutes of continuous icing every two hours for the first three days. An equally effective method is intermittent icing: 10 minutes on, 10 minutes off, then 10 minutes on again, repeated every two hours.
Use a bag of crushed ice or frozen peas wrapped in a thin towel. Never place ice directly on skin. Melting ice water (ice cubes in a plastic bag) is considered the safest and most efficient method because it holds a steady temperature without dropping cold enough to damage tissue. After the first 72 hours, you can reduce icing frequency to a few times a day or whenever swelling flares up.
How to Wrap a Sprained Ankle
A compression bandage limits swelling and gives your ankle some stability. Use an elastic bandage (like an ACE wrap) and follow a figure-eight pattern:
- Position your ankle at about a 90-degree angle, with your foot flat as if standing.
- Start at the toes. Begin wrapping where your toes meet the ball of your foot, making one full loop around the forefoot.
- Move diagonally across the top of the foot, around the ankle, and back under the arch, creating a figure-eight pattern.
- Work upward with each pass, moving toward the heel on the bottom and toward the calf on the top of the eight.
- End the wrap about 8 to 10 centimeters (3 to 4 inches) above the ankle and secure it with clips or tape.
Keep the wrap snug but not tight. If your toes go numb, turn white, or feel tingly, loosen it immediately. You’re cutting off blood flow. Rewrap the bandage every few hours, especially after icing, since swelling changes throughout the day.
Elevation
Prop your ankle above heart level whenever you’re sitting or lying down. This lets gravity drain fluid away from the injured area. Stack pillows under your calf (not just your foot) so the whole lower leg is angled upward. Elevation is most important in the first 48 to 72 hours, but continuing it for the first week helps keep swelling in check.
Ankle Braces and Supports
Once the initial swelling starts to settle (typically four to seven days after injury), switching from a compression wrap to a structured brace gives better long-term support. You have two main options: semi-rigid braces with hard plastic sides, and lace-up braces that look like a low boot. Both work well. A randomized trial comparing tape, semi-rigid braces, and lace-up braces found no meaningful difference in ankle function at six months. Pick whichever feels more comfortable and lets you move.
For moderate to severe sprains (where you can barely put weight on the ankle), a short period in a rigid walking boot followed by a semi-rigid or lace-up brace for up to six weeks is a common recommendation. The advantage of braces over athletic tape is that you can put them on yourself without needing someone trained in taping.
Over-the-Counter Pain Relief
Ibuprofen is the most common choice because it reduces both pain and inflammation. A typical dose is 400 mg every six to eight hours as needed. Acetaminophen (Tylenol) works for pain but doesn’t address inflammation, so it’s a better option if you can’t take anti-inflammatories due to stomach issues or other medications. A standard dose is 500 to 1,000 mg every six to eight hours. Naproxen (Aleve) lasts longer per dose and can be taken less frequently.
Anti-inflammatories are most useful in the first few days when swelling peaks. Taking them with food helps prevent stomach irritation. Avoid combining multiple anti-inflammatory drugs (like ibuprofen and naproxen together), though you can alternate ibuprofen with acetaminophen since they work through different pathways.
Topical Creams and Gels
Topical anti-inflammatory gels applied directly to the skin over the ankle can help with pain without the stomach side effects of oral medications. Arnica-based sprays and creams have a long history of use for sprains in Europe. A clinical trial on ankle sprains found that a combination spray containing arnica tincture and a topical pain reliever produced significantly better pain improvement than either ingredient alone or placebo. The effect was additive, meaning each ingredient contributed measurably to relief.
Topical options work best for mild to moderate sprains. They’re worth trying if you prefer to limit oral medication, but they won’t replace ice and compression for controlling swelling in the first few days.
When to Start Moving Again
The outdated advice was to rest completely until the pain disappeared. Current evidence strongly favors early functional movement. This means doing gentle range-of-motion exercises within the first few days, as long as you stay within your pain tolerance.
The simplest exercise is the “ankle alphabet.” Sit so your feet don’t touch the floor, then use your big toe to trace each letter of the alphabet in the air. Keep the movements small, using only your foot and ankle. This covers flexion, extension, and side-to-side motion without putting weight on the joint. Aim for two sets daily. You can also do basic up-and-down and circular motions for 20 to 30 minutes, at least three times a day.
This early movement prevents stiffness, promotes blood flow to the healing ligaments, and leads to better long-term ankle function compared to complete rest. A conditioning program of gentle exercises typically continues for four to six weeks as you gradually return to full activity.
Signs You May Need an X-Ray
Most ankle sprains don’t involve a fracture, but certain signs suggest a bone might be broken. The Ottawa Ankle Rules, used in emergency departments worldwide, flag two key indicators: tenderness when you press directly on the ankle bones (the bony bumps on either side) or the base of the fifth metatarsal (the bone that sticks out on the outer edge of your midfoot), and inability to take four steps immediately after the injury or when examined. If either applies, imaging is worth getting to rule out a fracture. If you can bear weight and the bony areas aren’t tender to touch, a sprain is far more likely than a break.