For a sprained ankle, over-the-counter pain relievers like ibuprofen or acetaminophen both work equally well. A 2007 study comparing the two found no difference in pain relief, swelling, bruising, or range of motion at four days post-injury. The bigger question is whether you should take anti-inflammatory medication at all, since newer evidence suggests inflammation is actually part of how your body heals.
Pain Relief: Ibuprofen vs. Acetaminophen
Most people reach for ibuprofen after a sprain, assuming the anti-inflammatory effect gives it an edge. But ankle sprains aren’t driven by the same inflammatory pathway that ibuprofen targets. The swelling after a sprain is caused by tissue damage and bleeding, not the prostaglandin-mediated process that makes ibuprofen useful for conditions like gout or arthritis. In clinical testing, 400 mg of ibuprofen three times daily performed no better than 1,300 mg of extended-release acetaminophen for pain on walking, swelling reduction, or recovery of motion.
This matters because ibuprofen and other NSAIDs carry risks that acetaminophen doesn’t, including stomach irritation and potential interference with tissue healing. If you need something to manage pain in the first few days, acetaminophen is a reasonable first choice. That said, the more important conversation is about whether suppressing inflammation early on is a good idea at all.
The Case Against Anti-Inflammatories Early On
A framework published in the British Journal of Sports Medicine argues that standard care for soft-tissue injuries should not include anti-inflammatory medications. The reasoning is straightforward: the various phases of inflammation are what drive repair of damaged ligaments and soft tissue. Suppressing that process with medications, especially at higher doses, may compromise long-term healing. The authors also questioned the use of ice for the same reason, noting there’s no high-quality evidence that cryotherapy helps soft-tissue injuries recover faster.
This doesn’t mean you need to suffer through severe pain. But it does suggest keeping medication use to the minimum effective dose and duration, particularly in the first 48 to 72 hours when your body’s inflammatory response is doing its most important repair work.
The PEACE and LOVE Protocol
The old advice of RICE (rest, ice, compression, elevation) has been replaced in sports medicine circles by a more comprehensive approach that covers both immediate care and longer-term recovery. The updated framework breaks into two phases.
Immediately After the Injury: PEACE
- Protect: Limit movement for one to three days to reduce bleeding and prevent further damage to injured fibers. But don’t rest longer than necessary, as prolonged immobilization weakens tissue.
- Elevate: Keep the ankle above heart level to help fluid drain away from the injury.
- Avoid anti-inflammatories: Skip NSAIDs and ice in the early phase to let your body’s natural repair process work.
- Compress: Use a bandage or tape to limit swelling and internal bleeding.
- Educate: Understand that an active recovery approach works better than passive treatments like ultrasound therapy, manual therapy, or acupuncture, which show insignificant effects on pain and function after acute injuries.
In the Days and Weeks After: LOVE
- Load: Start putting weight on the ankle and resuming normal movement as soon as pain allows. Gradual mechanical stress promotes repair and builds tissue tolerance.
- Optimism: Your mindset genuinely affects recovery. Catastrophizing, fear of re-injury, and depression are documented barriers to healing. Expecting a good outcome is associated with better results.
- Vascularization: Begin pain-free cardio exercise within a few days. Walking, swimming, or cycling increases blood flow to the injured area and supports healing.
- Exercise: Targeted exercises to restore mobility, strength, and balance have strong evidence behind them for ankle sprains. They also significantly reduce the chance of spraining the same ankle again.
Nutrition That Supports Healing
What you eat in the weeks following a sprain can influence how quickly damaged tissue repairs itself. Protein is the most critical macronutrient for tissue rebuilding. Aim for roughly 75 grams per day if you’re female and 100 grams if you’re male, spread across meals so each one contains a meaningful amount. This supports collagen synthesis and helps prevent muscle loss during reduced activity.
Omega-3 fatty acids from fish oil help your body produce compounds involved in resolving inflammation once it’s done its job. Research suggests 2.5 grams per day of combined EPA and DHA (the active forms found in fish oil supplements) can meaningfully reduce inflammatory markers. Eating fatty fish like salmon, sardines, or mackerel several times a week contributes to this goal, though supplementation may be needed to reach therapeutic levels.
Colorful fruits and vegetables supply polyphenols, particularly anthocyanins found in berries, cherries, and red cabbage. These compounds support the resolution phase of inflammation. Keeping overall sugar and refined carbohydrate intake low also helps by reducing blood sugar spikes that can amplify inflammatory stress in the body.
Recovery Timelines by Severity
How long your sprain takes to heal depends on the degree of ligament damage. A Grade 1 sprain, where the ligament is stretched but not torn, typically resolves in one to three weeks. A Grade 2 sprain involves a partial tear and takes three to six weeks. A Grade 3 sprain, meaning a complete ligament tear, or a high ankle sprain involving the ligaments above the ankle joint, can take several months.
These timelines assume you’re actively rehabilitating, not just waiting for pain to disappear. Returning to full activity without rebuilding strength and balance is the most common reason people re-sprain the same ankle. Even a mild sprain benefits from balance exercises (like standing on one foot) and progressive ankle strengthening once pain-free movement is possible.
When You Might Need an X-Ray
Not every sprained ankle needs imaging. Emergency departments use a validated checklist called the Ottawa Ankle Rules to determine whether an X-ray is warranted. You likely need one if you have tenderness when pressing on the bony bumps on either side of your ankle (the back edge or tip of the bones, not the soft tissue in front), tenderness at the base of the small toe bone on the outside of your foot, tenderness at the bone on the inner midfoot, or if you couldn’t take four steps either right after the injury or when being evaluated. If none of these apply, the chance of a fracture is very low and a sprain can be managed without imaging.