Most of what people believe about the first two days comes from a poster in a school changing room. Some of it still holds. A fair amount of it has moved on, and the part that has moved on is the part about rest.
The first day
Protect it, but do not wrap it in cotton wool. Stop the activity that caused it and avoid anything that provokes sharp pain. That is different from complete rest — a joint or muscle that is not moved at all stiffens quickly, and the stiffness is usually harder to undo than the original injury.
Compression helps. A simple elastic bandage, firm but not tight enough to throb or change the colour of the skin below it, limits swelling and generally makes the area feel more secure.
Elevate it if you can. Above the level of the heart where that is practical, which for a lower limb mostly means lying down rather than sitting with it up on a stool.
Ice is for comfort. Fifteen to twenty minutes, wrapped in a damp tea towel rather than straight onto skin, and not while you are asleep. It is genuinely good at dulling pain in the first day or two. The evidence that it speeds healing is much weaker than its reputation suggests, so use it because it makes the area more comfortable, not because you think it is repairing anything.
The second day, and after
Start moving it gently. Within whatever range is comfortable, without forcing anything. Movement drives the fluid out, keeps the joint from stiffening and gives the healing tissue a reason to lay itself down in a useful direction. This is the single most important thing you can do, and it is the one most people skip.
Keep loading the rest of you. A sore ankle is not a reason to stop training your upper body. Deconditioning is a real cost of an injury, and an avoidable one.
Be careful with anti-inflammatories. They work, but early inflammation is part of how tissue repairs. If you are taking them purely so you can push through and carry on as normal, you are borrowing against the repair. Ask a pharmacist or your GP if you are unsure — that is a medical question, not one for a therapist.
What not to do yet
No deep massage directly on a fresh injury, no aggressive stretching, and no heat in the first couple of days while it is still swelling — heat increases blood flow to an area that already has more than it wants.
Hands-on work has plenty to offer at this stage, but it belongs around the injury rather than on it: keeping the surrounding tissue moving, and stopping the rest of the limb from stiffening up in sympathy.
When it is not one for a therapist
Go to A&E or an urgent care centre, rather than waiting for an appointment, if any of the following apply:
- You cannot put weight on it at all, or the joint looks out of shape.
- It swelled up hard and fast, within an hour of the injury.
- The joint gives way, locks, or will not straighten.
- There is numbness, pins and needles, or the area below it looks pale or feels cold.
- You heard or felt a distinct pop at the moment it happened, especially at the knee or the Achilles.
None of that means the worst. It means the question needs answering by someone who can image it, and that is not a soft tissue therapist.
Then what
Once the acute phase settles — usually two to four days — the job changes from settling it down to getting it moving and rebuilding it. That is where assessment earns its place, because the important question by then is not what happened but what is still not working.