Ankle sprains are really common. Around one in 10,000 people injure the ligaments on the outside of their ankle every day. They make up about a quarter of all sports injuries. But anti-inflammatories like ibuprofen don’t suit everyone, and experts still disagree about the best time to take them.
This guide covers what the research shows, what you can buy in the UK, who should check before taking anti-inflammatories, and when a sprain needs more than a trip to the pharmacy. If you’d like the basics first, start with what ankle sprains are and how to treat them.
Key takeaways
- Anti-inflammatories (also called NSAIDs) can ease pain and swelling after a sprain. Research supports using them early on, although the evidence is limited.
- Gels and sprays probably relieve pain about as well as tablets, and few serious side effects have been reported with them.
- PEACE & LOVE guidance (see below) advises caution in the first days, so it’s worth weighing up whether to take them.
- Paracetamol, co-codamol and Zapain are painkillers, not anti-inflammatories.
- Check with a pharmacist or GP first if you’re pregnant, take blood thinners or have ulcers, asthma or a heart, liver or kidney condition.
- Take the smallest dose for the shortest time. The NHS says not to take ibuprofen tablets for more than 10 days without advice.
Should you take an anti-inflammatory for a sprained ankle?
If you’re otherwise healthy, you can often take them with no problems. NSAIDs can take the edge off pain and swelling. They don’t repair the ligament, though, and they aren’t essential for recovery.
What the research shows
Struijs and Kerkhoffs looked at studies comparing anti-inflammatory tablets, gels and dummy treatments (placebos) for ankle sprains. A separate review cautiously concluded that NSAIDs are worth using in the early stages of a sprain.
Tablets eased pain better than placebo when walking and resting, and also reduced swelling. Gels worked better than placebo too. No studies compared tablets directly with gels for ankle sprains, so we can’t say which works better for this injury.
The authors were open about the limits. There were only a few studies, some were better quality than others, and the patient numbers were small. So NSAIDs probably help, but the evidence isn’t as strong as we’d like.
A Cochrane review of 61 studies on topical NSAIDs (gels) found that they relieved pain from sprains and strains probably about as well as tablets. Very few people had side effects other than skin irritation.
The NHS advice for sprains and strains is practical. Try using paracetamol for pain and ibuprofen gel, mousse or spray for swelling to start with. You can use ibuprofen tablets, capsules or syrup if you need them, and a pharmacist can help you choose.
The healing question: PEACE & LOVE
Inflammation (swelling) is part of how the body repairs a stretched or torn ligament. Some researchers worry that reducing it could hold up repair. That idea is behind PEACE & LOVE, an approach published in the British Journal of Sports Medicine. Its authors say anti-inflammatories help with pain and function, but they may slow healing.
PEACE covers the first few days:
- Protect (avoid movements that make the pain worse)
- Elevate (raise it level with or higher than your heart)
- Avoid anti-inflammatory medicines
- Compress (use an elastic bandage to apply steady pressure)
- Educate (learn about the injury)
LOVE covers what comes next:
- Load the ankle gently
- Optimism (staying positive can help your recovery)
- Vascularisation (getting the blood flowing with movement)
- Exercise to get your strength and mobility back
It hasn’t been proven that a short course of tablets slows recovery from an ankle sprain, so it depends on how you’re feeling.
- If your pain is manageable, you may not need anything.
- If pain is stopping you from sleeping or walking, a gel or a short course of tablets may be reasonable.
- If you take other medicines or have a health condition, ask a pharmacist first.
Many people still follow the older RICE approach. Our guide explains how it compares.
Which anti-inflammatories can you buy in the UK?
NSAID stands for non-steroidal anti-inflammatory drug. These medicines reduce the chemicals in your body that cause pain and swelling. They come as tablets, capsules, gels, sprays and patches.
Gels and sprays
Ibuprofen and diclofenac gels (Voltarol is a well-known brand) are rubbed into the skin over the sore area. Only a small amount of the NSAID actually gets into your bloodstream, which is why they carry less risk than tablets for many people.
The NHS says not to use gels or sprays more than four times in 24 hours. Wash your hands afterwards and keep them away from broken skin, your eyes and your mouth.
Tablets and capsules
Ibuprofen is the one most people know. It’s sold in shops and pharmacies under names such as Nurofen. The NHS says adults can take one or two 200mg tablets up to three times a day if they’re still in pain. Leave at least four hours between doses and don’t take more than six 200mg tablets in 24 hours. Take them with or after food.
Other NSAIDs, such as naproxen and diclofenac tablets, are usually prescribed or given on a pharmacist’s advice. Never take two different NSAIDs at the same time.
Are anti-inflammatories different from other painkillers?
Yes, and people often mix them up. Medicines like Zapain, co-codamol or co-dydramol aren’t anti-inflammatories, but they are painkillers.
Paracetamol eases pain but doesn’t reduce swelling. Co-codamol combines paracetamol with codeine, and Zapain is a brand name for co-codamol. Co-dydramol combines paracetamol with dihydrocodeine. These combination painkillers can help, but they may make you drowsy or constipated.
If you’re choosing between paracetamol and ibuprofen, paracetamol is usually gentler on the stomach, but ibuprofen also helps with swelling. A pharmacist can help you decide.
Who should check first?
The NHS says to speak to a pharmacist or doctor before taking ibuprofen if you:
- Have had an allergic reaction to ibuprofen, aspirin or another NSAID.
- Currently have a stomach ulcer or have had one in the past.
- Have asthma, allergies or chickenpox.
- Have a heart, liver or kidney condition, a blood clotting problem or have had a stroke.
- Are pregnant, trying for a baby or breastfeeding.
Some medicines don’t mix well with ibuprofen. These include blood thinners such as warfarin, steroids, antidepressants and blood pressure tablets. This NHS advice is for adults aged 18 or over, so ask a pharmacist about children. Alcohol can make side effects worse, so keep it to a minimum.
How long should you take them?
Take the smallest dose that works for the shortest time. The NHS says not to take ibuprofen tablets or capsules for more than 10 days without advice. For many sprains, a few days is enough.
Side effects can happen. If you have stomach pain that doesn’t get better, dark or bloody stools, wheezing or a rash, stop taking them and speak to a pharmacist or your GP. If your lips or face swell up, get medical help straight away.
When is medication not enough?
Tablets and gels help symptoms, but they can’t tell you whether a bone is broken or a ligament is badly torn. Get your ankle checked quickly if:
- You can’t put weight on it or take four steps.
- The bone at the back of your ankle or the outer edge of your foot is tender to touch.
- Your ankle looks out of shape, or your foot is numb or pale.
- The swelling and bruising are severe or spreading.
Your GP, an urgent treatment centre, or A&E can help, depending on how urgent it feels.
Even without those signs, some sprains take longer to heal. Pain that lasts more than six weeks, or an ankle that keeps giving way or clicking, is worth getting checked. Our article on a sprained ankle that hasn’t healed explains the usual causes. If the ligaments stay loose, ligament reconstruction may be considered, but only after other treatments have been tried.
What a specialist review involves
A foot and ankle consultant will start by asking how the injury happened, what you’ve tried and what you want to get back to. Then they’ll examine your ankle, checking the ligaments, joints and bones around it. They might arrange an X-ray, ultrasound or MRI if they think it’s needed.
Treatment usually starts with non-surgical options. These can include a supportive brace, physiotherapy and advice on medicines. Surgery is only considered if your ankle is still unstable after a good period of rehabilitation. Our guide to how an ankle sprain is treated gives more detail.
Get an expert opinion on your ankle injury
Mr Francesc Malagelada is a Consultant Trauma and Orthopaedic Surgeon and a senior trauma consultant at the Royal London Hospital, where he treats ankle fractures of all severities. You don’t need a GP referral to book a specialist assessment.
Frequently asked questions
Is ibuprofen or paracetamol better for a sprained ankle?
Ibuprofen reduces pain and swelling, while paracetamol only eases pain. Paracetamol is usually gentler on the stomach. A pharmacist can help you choose based on your health and any other medicines you’re taking.
Is naproxen good for a sprained ankle?
Naproxen is another NSAID and can ease pain and swelling. It’s usually prescribed or given on a pharmacist’s advice, and the same cautions apply as for ibuprofen.
Is Zapain an anti-inflammatory?
No. Zapain contains paracetamol and codeine, so it’s a painkiller, not an NSAID. It doesn’t reduce swelling.
Can I use a gel instead of tablets?
Yes, many people do. Reviews suggest gels probably help with pain about as well as tablets, with few side effects beyond skin irritation. They can be a good option if you’d rather avoid tablets.