Ankle sprains are among the most common musculoskeletal injuries experienced by people of all ages and activity levels. Whether it occurs during sports, walking on uneven ground, or simply taking a misstep, an ankle sprain can significantly impact mobility and quality of life. While some sprains heal with minimal intervention, others require a structured rehabilitation plan to ensure full recovery and prevent re-injury.
In this comprehensive guide, we’ll explore what an ankle sprain is, how to identify its severity, and – most importantly – what to do after spraining your ankle to facilitate optimal healing.
What is an Ankle Sprain?
An ankle sprain occurs when the ligaments that support the ankle joint are stretched or torn, typically due to a sudden twisting or rolling movement. Most ankle sprains happen when the foot rolls inward – an injury known as an inversion sprain. This places excessive stress on the ligaments on the outside of the ankle, particularly the anterior talofibular ligament (ATFL).
The ATFL is the most commonly injured ligament in ankle sprains. It plays a crucial role in stabilising the ankle, and any injury to it can affect your ability to walk, run, or bear weight effectively.
Types and Severity of Ankle Sprains
Not all ankle sprains are created equal. Their severity is typically classified into three grades:
- Grade I (Mild): Slight stretching and microscopic tearing of ligament fibres. Mild tenderness, swelling, and stiffness may be present.
- Grade II (Moderate): Partial tearing of the ligament. This grade often results in moderate pain, noticeable swelling, bruising, and difficulty walking.
- Grade III (Severe): A complete tear of the ligament, causing significant instability, pain, swelling, and often an inability to bear weight.
When a Sprain May Be More Than It Seems
While ankle sprains are common, it’s essential to differentiate them from more serious injuries like fractures. One such example is an avulsion fracture of the lateral malleolus, the bony prominence on the outside of the ankle. In this injury, the ligament pulls off a small piece of bone from the fibula, and the symptoms can closely mimic those of a severe sprain.
Signs That You Might Have a Fracture:
- Inability to bear weight even briefly after the injury
- Severe swelling and bruising
- A visible deformity
- Tenderness directly over the bone
In such cases, it’s crucial to seek medical assessment, which may include x-rays or ultrasound imaging, to rule out fractures or more complex ligament injuries.
Immediate Treatment: What to Do Right After an Ankle Sprain
If you suspect you’ve sprained your ankle, immediate management is vital. Follow the R.I.C.E. protocol in the first 48–72 hours:
- Rest: Avoid putting weight on the ankle. Crutches or a moon boot may be necessary for more severe injuries.
- Ice: Apply ice packs for 15–20 minutes every 2–3 hours to reduce swelling and pain.
- Compression: Use an elastic bandage or compression wrap to limit swelling and support the joint.
- Elevation: Keep the ankle elevated above the level of the heart as much as possible.
💡 Pro Tip: Avoid heat, alcohol, and massage in the first 48 hours, as these can increase swelling and delay healing.
When to See a Physiotherapist
If your symptoms haven’t improved within the first 2 to 3 weeks, or you’re unable to upgrade your activity level without discomfort, it’s time to consult a physiotherapist. A professional assessment can rule out more serious injuries and help guide a structured recovery program tailored to your needs.
Your physiotherapist may recommend:
- Temporary immobilisation (e.g. using a moon boot)
- Ankle taping or bracing
- Gentle mobilisation exercises
- Gradual weight-bearing activities
- A progressive exercise program focusing on strength, mobility, and proprioception
Stages of Ankle Sprain Rehabilitation
1. Acute Phase (Days 1-7)
Focus: Pain management and protection
- Continue with R.I.C.E.
- Begin gentle range-of-motion (ROM) exercises like ankle circles and alphabet tracing
- Use crutches or a moon boot if needed
2. Subacute Phase (Week 2-3)
Focus: Restoring movement and preventing stiffness
- Start gentle weight-bearing exercises as tolerated
- Include stretching and mobility drills
- Begin light strengthening exercises, such as towel scrunches or resistance band movements
3. Strength and Proprioception Phase (Weeks 3-6)
Focus: Rebuilding ankle strength and coordination
- Implement resistance exercises (e.g., calf raises, resistance band eversions/inversions)
- Perform balance training using a wobble board or standing on one foot
- Continue progressing ROM and functional mobility
4. Return to Activity (6+ Weeks)
Focus: Sport-specific drills and injury prevention
- Integrate plyometric and agility drills (e.g., hopping, lateral movements)
- Continue proprioceptive training
- Resume running or sports under guidance
⚠️ Note: Returning to full activity too soon increases the risk of chronic ankle instability—a condition marked by repeated sprains and persistent weakness.
Preventing Future Ankle Sprains
Once you’ve recovered, it’s important to take steps to prevent future injuries. Here’s how:
- Strengthen the ankle and foot muscles regularly
- Stretch the calves and Achilles tendon
- Practice balance and proprioception exercises
- Wear supportive footwear suited to your activity
- Use taping or a brace during high-risk activities, especially if you have a history of sprains
Regular follow-ups with a physiotherapist can ensure you’re progressing correctly and not overloading your joint too soon.
When to Get Medical Imaging
Sometimes, diagnostic imaging is necessary to confirm the extent of an ankle injury. Your physiotherapist or GP may recommend:
- X-rays: To rule out fractures
- Ultrasound: To detect soft tissue injuries
- MRI: In chronic or unclear cases, to assess ligament and cartilage damage
Don’t Ignore an Ankle Sprain
Ankle sprains may be common, but they should never be underestimated. Without appropriate management, even a mild sprain can lead to long-term pain, weakness, or instability. The key to a full recovery lies in early intervention, proper diagnosis, and a structured rehabilitation plan.
If you’ve recently injured your ankle or suspect a sprain, don’t delay – reach out to your local physiotherapist. They’ll help you navigate the recovery journey, reduce the risk of re-injury, and return to the activities you love with confidence.
Need Help With an Ankle Sprain?
Whether it’s your first sprain or a recurring issue, our experienced physiotherapists are here to help. We provide personalised treatment plans tailored to your recovery goals.
📞 Call today to book an appointment and take the first step toward a stronger, healthier ankle.
