Why You Don't Need An X-Ray For Your Ankle Sprain

healthcare physical therapy Mar 22, 2019

By: Molly King



Ankle sprains are one of the most common orthopedic injuries occurring in sports, and it is the most commonly seen orthopedic injury in emergency rooms.  Most people who sprain their ankle feel it is necessary to go to the emergency room to make sure that the ankle isn’t broken, but the vast majority of the time, this is an unnecessary, and expensive, step on the path to recovery.  Only 15% of sprained ankles that are assessed by a medical professional (not counting the many that are do not receive formal diagnosis and care) are also fractured. Below are a list of simple tests you can do at home after an ankle sprain to determine if a trip to the ER is necessary, saving you time and money.


The Ottawa Ankle Rules

The Ottawa Ankle Rules are a series of diagnostic tests used to determine if an x-ray is required.  Ask yourself these four questions:

  1. Can you take four steps (it is okay to limp):  If NO, go to ER.
  2. Is there tenderness if you press on your medial or lateral malleolus (bony bumps on the outside of the ankle):  If YES, go to ER.
  3. Is there tenderness if you press along the base of your 5th metacarpal (outside of your foot below your ankle):  If YES, go to ER.
  4. Is there tenderness if you press along your navicular (bony bump on inside edge of foot just below your ankle):  If YES, go to ER.


Now What?:  Tips for Home Care

So you’ve determined that you don’t need an x-ray.  Where do we go from here?  Let’s start with RICE.  Immediately after injury, begin the RICE protocol to manage pain and inflammation while your body starts the natural healing process. If your ankle continues to limit your activity after three days, or if you’ve sprained your ankle multiple times, see a physical therapist for expert assistance.

Rest:  Avoid high impact activities like running or jumping.  Avoid prolonged walking if it is painful to do so.  Gentle ankle circles to prevent stiffness are okay.

Ice:  20-30 minutes every 2-3 hours for the first 3 days after injury

Compression:  Use an ace wrap or compression sleeve to reduce swelling

Elevation:  20-30 minutes every 2-3 hours for the first 3 days after injury


Prevention and Treatment Do’s and Don’ts:

Don’t: Boot It Up

It has long been standing protocol in many emergency rooms, family medicine practices, and even some orthopedic clinics to put anyone who has suffered an ankle sprain in a walking boot or on crutches for several weeks.  Unless the ankle is fractured or the ligaments that stabilize your ankle are completely torn (very rare), a walking boot and/or crutches are not necessary and can actually delay your return to sport. These devices cause gait abnormalities, decrease strength in the muscles of the foot and lower leg, increase stiffness in the muscles and joints of the ankle, impair balance, and reduce proprioception (your body’s ability to recognize where it is in space).


Do:  Start Physical Therapy ASAP

Not only can physical therapy improve ankle sprain symptoms immediately after an injury, it can also help you prevent future ankle sprains.  Manual therapy can help reduce swelling, decrease pain levels, and improve range of motion. Balance, sport specific agility training, and lower body strengthening exercises are imperative to getting you back in the game and keep you there by reducing your risk of future injuries.


Don’t:  Tape or Brace

A longstanding “preventative” practice, we now know that taping and bracing do absolutely nothing to reduce your risk of ankle sprains.  Tape is virtually useless within 7 minutes of application under the best circumstances. Athletes wearing ankle braces lose proprioception, their body’s ability to recognize where it is in space, in their ankles, which predisposes them to future injuries.


Do:  Ankle “Prehab” Program

Whether it is with a physical therapist, a sport performance coach or on your own at home, a long term ankle “prehab” program is imperative to prevent future ankle sprains.  Exercises should focus on mobility, balance, agility, and total body strength.


I hope you’ve found value and knowledge in this article.  If you have any comments or questions, please leave them below or feel free to email me at [email protected]  

Follow Dr. Molly on Instagram @mollykingdpt


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