Immediate care after the injury should follow the RICE principle: Rest, Ice (cold application), Compression and Elevation. The aim of this management is to minimize inflammation, hemorrhage, pain and cellular metabolism during the acute post-injury phase, to optimize the potential for subsequent recovery.

Protection of the injured ligaments by immobilization for 1-3 weeks after injury has 2 objectives. Immobilization allows healing to begin and proceed undisturbed. This is important for development of strong new collagen fibers across the area of injury, as mobilization of the injured ligament too early may result in weaker collagen fiber formation. Secondly, immobilization prevents re-injury of the ligament which is likely to result in new pain and cause distention and/or lengthening/stretching of the injured ligament. This predictably results in longer recovery times and may have long term effects of permanent ankle laxity (giving way under stress), loss of strength, ankle stiffness or chronic pain.

Introduction of controlled mobilization once ligamentous healing and scar tissue formation is well advanced (about 3 weeks post injury) begins rehabilitation of the injury and helps avoid the negative effects of prolonged immobilization (muscle atrophy, loss of joint flexability). Movement of the healing ligament also helps align newly formed collagen fibers to parallel the lines of stress in the ligament, which will improve the mechanical and structural properties of the healing ligament.

Beyond 4-8 weeks post injury, the newly formed collagen that repairs the injury should be able to withstand close to normla stresses on the ligament, and so rehabilitation efforts can focus on regaining full joint and muscle functions. It must be remembered, however, that full recovery of the injured ligaments takes from 6-12 months.

Orthopedic repair of severe injuries is often done as soon as the acute swelling and hemorrhage of the injury subsides, and although these are actually procedures that repair damage, for purposes of recovery and rehabilitation, they should be considered new injuries to the joint and the 4 components of recovery described above should be applied even after surgical repair to increase the liklihood of full recovery as much as possible.