Background Acute ankle sprains are usually managed functionally, with advice to undertake progressive weight-bearing and walking. Mechanical loading is an important modular of tissue repair; therefore, the clinical effectiveness of walking after ankle sprain may be dose dependent. The intensity, magnitude and duration of load associated with current functional treatments for ankle sprain are unclear.

Aim To describe physical activity (PA) in the first week after ankle sprain and to compare results with a healthy control group.

Methods Participants (16–65 years) with an acute ankle sprain were randomised into two groups (standard or exercise). Both groups were advised to apply ice and compression, and walk within the limits of pain. The exercise group undertook additional therapeutic exercises. PA was measured using an activPAL accelerometer, worn for 7 days after injury. Comparisons were made with a non-injured control group.

Results The standard group were significantly less active (1.2±0.4 h activity/day; 5621±2294 steps/day) than the exercise (1.7±0.7 h/day, p=0.04; 7886±3075 steps/day, p=0.03) and non-injured control groups (1.7±0.4 h/day, p=0.02; 8844±2185 steps/day, p=0.002). Also, compared with the non-injured control group, the standard and exercise groups spent less time in moderate (38.3±12.7 min/day vs 14.5±11.4 min/day, p=0.001 and 22.5±15.9 min/day, p=0.003) and high-intensity activity (4.1±6.9 min/day vs 0.1±0.1 min/day, p=0.001 and 0.62±1.0 min/day p=0.005).

Conclusion PA patterns are reduced in the first week after ankle sprain, which is partly ameliorated with addition of therapeutic exercises. This study represents the first step towards developing evidence-based walking prescription after acute ankle sprain.