The management of an acute lateral ankle sprain (LAS) affects long-term outcomes, which highlights the need for assessment of practice at the point of care. The purpose of this retrospective chart review was to examine the management strategies for acute LAS as documented in a secondary school’s electronic medical records (EMR) over 2 years. Patient charts noting a LAS diagnosis (n = 107) were identified from the EMR. Most charts indicated palpation and anterior drawer test performance. Cryotherapy (82%) and compression (55%) varied in use. Therapeutic rehabilitation and return-to-activity testing were underreported. Overall, clinical management of acute LAS may not align with best available evidence.