Most people who play sport roll an ankle at some point. Most of us shrug it off, hobble around for a few days and get back to it, which is also why it’s the injury most likely to happen again. Doing the first few days well and finishing the rehab are what separate a one-off sprain from a recurring problem.
Understanding ankle sprains
Most ankle sprains affect the ligaments on the outside of the ankle, which are stretched or torn when the foot rolls inwards. They’re graded by how much damage there is:
- Grade 1: the ligament is stretched. Mild swelling and tenderness, and you can usually still walk
- Grade 2: a partial tear. More swelling and bruising, noticeable pain walking and some looseness
- Grade 3: a complete tear. Significant swelling and bruising, and it’s hard or impossible to bear weight
Symptoms we commonly see
- Pain and swelling around the outside of the ankle, often with bruising that tracks into the foot
- Pain putting weight through the foot, or a feeling of the ankle giving way
- Stiffness, especially bending the ankle upwards
- Weakness and a loss of balance on the affected leg, even after the pain settles
Our evidence-based approach
Guidelines for ankle sprains advise external support such as a brace or tape, progressive weight-bearing, and early exercise rather than immobilising the ankle. For the first days, the PEACE approach is a useful guide: protect the injury briefly, elevate, avoid anti-inflammatories where possible, compress, and educate, before moving into the LOVE phase of optimism, loading, vascularisation through exercise, and exercise itself. Our approach includes:
- Prompt assessment to confirm the grade, check for a fracture using established screening rules, and look for other injured structures
- Early management of pain and swelling, with taping or bracing and progressive loading rather than prolonged rest
- Restoring range and strength, including the calf and the muscles on the outside of the ankle that control rolling
- Balance and control training, from single-leg balance through to unstable surfaces
- Sport-specific work: hopping, landing, cutting and changing direction, progressed as the ankle tolerates it
- VALD strength testing to compare calf and outer-ankle strength with the other leg, so you return on measured criteria rather than how it feels
- A prevention plan, because balance training combined with a brace or tape during sport reduces the risk of repeat sprains in people who have sprained before
You can see typical ankle and calf strength targets on our strength standards page, and our taping service covers ankle support for sport.
What to expect: recovery timeline
- Mild (grade 1) sprains: often one to three weeks
- Moderate (grade 2) sprains: typically four to eight weeks of structured rehabilitation
- Severe (grade 3) sprains: may take several months, and sometimes need a surgical opinion
- Returning to sport: earlier than the strength and balance work allows is the most common way a sprain becomes a recurring problem
When to seek help urgently
Get assessed promptly if you can’t take four steps, there’s tenderness directly on the bone at the back of the ankle bumps, the base of the foot on the outer side or the inner midfoot, there’s obvious deformity or a loud pop with immediate significant swelling, or you have numbness or the foot looks pale or cold. These are the signs doctors use to decide whether an X-ray is needed.
References
- Martin RL, et al. Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80.
- Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72-73.
- Beckenkamp PR, Lin CC, Macaskill P, Michaleff ZA, Maher CG, Moseley AM. Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis. Br J Sports Med. 2017;51(6):504-510.