A sprained ankle can happen to pretty much anyone. It can occur while playing your respective sport, walking across the grass and stepping in an inconspicuous hole, stepping off of a curb wrong, or simply taking a misstep around the house. A sprained ankle occurs when you stretch or tear the ligaments that provide support to your ankle. Most sprained ankles will heal on their own with time. However, ensuring a smooth and more efficient recovery takes more effort. Physical therapy for a sprained ankle helps not only to recover from the initial injury, but reduces your risk from recurring injuries. This includes returning to activities too early and reinjuring the ankle before it even gets a chance to fully heal. This post will review the anatomy of the ankle, discuss what an ankle sprain really is, and go over physical therapy exercises and other important advice on how to recover from a sprained ankle.
TAKE ME STRAIGHT TO THE EXERCISES I SHOULD TRY!
**This is not medical advice. Please consult your medical provider for more information.
Understanding Lateral Ankle Ligament Anatomy
An ankle sprain occurs when you stretch or tear the ligaments of the ankle. Ligaments are a type of connective tissue that attaches one bone to another bone. This connection between bones creates stability for a joint. While the ankle has many different ligaments, the most common ligaments injured from a sprained ankle are the ligaments on the lateral side (outside of the ankle).
There are three major ligaments on the outside of the ankle. They are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). Ankle sprains can occur with injury to either one or more of these ligaments. Most often, the ATFL is injured in an ankle sprain.
The Importance of Rehabilitation After a Sprained Ankle
Did you know that lateral ankle sprains are the most common musculoskeletal injuries suffered by athletes and individuals participating in recreational activities? They also have the highest reinjury rate. Within the first year of spraining your ankle, you have a twofold increase in reinjury rate. For individuals who experience a more severe sprained ankle or multiple sprained ankles on the same side are more likely to develop chronic ankle instability. Typically, reinjury of the lateral ankle ligaments occurs due to inadequate rehabilitation and/or early return to sport1.
Chronic ankle instability can lead to even more impairments than an acute ankle sprain. Not only can you develop sensorimotor impairments on the injured side, but it has also been seen to affect sensorimotor function on the uninjured side too2. This can affect your foot posture, single leg balance, and proprioception (the ability to tell where you are in space).
Ensuring that your ankle sprain gets the time it needs to recovery, as well as important rehabilitation exercises, will help reduce the risk of reinjury and help protect your ankle from developing chronic ankle instability and the subsequent impairments that come with it.
Grades of Sprained Ankles
The severity of a sprain is determined by the “grade.” Here are the classifications for ankle ligament injuries:
- Grade I: This is a mild ankle sprain. It typically only involves the ATFL. A grade I ankle sprain is the most common type of ankle sprain. It can take a few weeks to recover.
- Grade II: This is a moderate ankle sprain. It typically involves both the ATFL and CFL. There will be more laxity of the ankle compared to a grade I sprain. This can take a couple of months to recover from.
- Grade III: This is a severe ankle sprain. This type of ligament injury involves a full ligament tear. It also involves all three lateral ankle ligaments—the ATFL, CFL, and PTFL. There is a lot more laxity of the ankle compared to the grade II secondary to the full ligament tear. This type of injury can sometimes involve surgery and will take over 3 months to recover.
Remember, the timeline for recovery will be determined by the severity of the ankle sprain. In more severe ankle sprains, it is important to check for any other signs of injury, including ankle fractures.
When to Get an X-Ray (The Ottawa Ankle Rules)
Unsure as to whether you should get an Xray after a really bad ankle sprain? Use the Ottawa Ankle Rules as a guide! An X-ray of the ankle is indicated if:
- There is pain in the malleolar zone (the area around the bones on the inside/outside of the ankle), and
- Any of the following:
- Inability to bear weight both immediately at injury or in your initial evaluation for the first 4 steps (could be in the emergency department or with another healthcare provider).
- Bone tenderness at the medial malleolus or the distal 6cm of the posterior edge of the tibia
- Bone tenderness at the lateral malleolus or the distal 6cm of the posterior edge of the fibula
It is important to remember that these are the Ottawa ankle rules for the ankle. The Ottawa Ankle rules are slightly different for a foot fracture.
Early Sprained Ankle Rehabilitation Exercises
The key to early rehab with sprained ankles is early mobility! You want to get the ankle moving as quickly as possible. Granted, it will hurt in the beginning, but there are safe and effective exercises to kickstart your journey to recovery.
Just be careful when moving the ankle into inversion, that is, moving the toes/ankle inward. This stresses the lateral part of the ankle, including the ligament(s) that is injured. It is safe to gently move the ankle inward when performing the ankle alphabet exercise listed below, but be careful with how far you push your ankle in the very early stages of healing. As your injury begins to recover, you will not have to worry about this as much.
Ankle Alphabet
While sitting, draw the alphabet with your ankle/foot. Start with the letter “A” and go all the way to letter “Z.”
Make sure your movement is from the ankle itself and you aren’t moving the entire leg.
Go one time through the alphabet when first starting. As this gets easier, complete a second round.
Towel Scrunches
Sit with your foot on the ground and on top of a large towel.
Curl or scrunch your toes and try curling the towel towards you. Try to only curl your toes and don’t move the entire foot or leg to bring the towel closer to you.
Complete 3 sets of 10-15 reps.
Alternating Seated Heel and Toe Raises
Sit with your feet flat on the ground.
Push up onto your toes by lifting your heels. Then lower your heels back to the ground and then lift your toes and the balls of your feet. Keep alternating between these two positions.
Perform 2-3 sets of 10-12 reps.
Tandem Balance
Using the countertop, wall, or other supportive surface for assistance, standing with one foot in front of the other. You want your heel of one foot connected to the toe of the other foot.
Balance in this position. If you need the assistance of the countertop or wall, use it as needed. For more of a challenge, remove your hands from holding onto the supportive surface. Only move your hands when you are confident you can maintain your balance.
Balance for 15-30 seconds and repeat 2-3 times with each foot in front.
Progressing Sprained Ankle Rehabilitation
Depending on the severity of your ankle sprain will determine how quickly you are able to progress towards the next phase of rehabilitation. You want to ensure that there is no pain with walking and that your swelling (if any) is kept to a minimum. It is expected that in more severe cases of ankle injury, occasional swelling can happen for some time. You want to see that over time, the swelling occurs less frequently and there is less swelling overall than when you initially injured it.
For individuals looking to return to sport or heavy activities, rehab will take longer as there is more that needs to recover in order to ensure safe return to your usual activities. We need to see that your ankle and the rest of your leg has adequate strength to withstand running, jumping, and cutting. You should have good balance and be able to demonstrate corrective movements when you lose your balance or take a misstep to help reduce chances of reinjuring the ankle. While there is no way to completely prevent injuries from occurring, we want to take all necessary precautions to help limit the chances of reinjuring the ankle.
Your physical therapist will be able to guide you with when it is appropriate to progress your training regimen. They will be able to accurately assess your range of motion, strength, and balance and be able to assess your movements to determine what you specifically need to work on to return to where you were at pre-injury.
When to See a Doctor
When we talk about managing a sprained ankle, one crucial step is knowing when to see a doctor. It’s easy to dismiss a sprain as a minor issue, but certain symptoms should prompt you to seek immediate medical attention. Here are those non-negotiable signs:
- Severe pain and swelling: If the pain and swelling around your ankle are severe and get worse over time, it may indicate something more serious than a basic sprain. The Ottawa Ankle rules can help guide if an Xray or other imaging may be needed.
- Signs of infection: Redness, warmth, fever, or a feeling of heat can indicate an infection, demanding immediate medical attention.
- No improvement with home care: If conservative at-home treatment is getting you nowhere, consult a healthcare professional.
- Failed conservative treatment: Your physical therapist can help determine this if you have been working together for some time. Seeing minimal to no progress over a length of time even with physical therapy warrants a check-in with your doctor.
Pain Management and Other Advice for Ankle Sprains
There are many questions that get asked regarding what to do for pain with ankle sprains. In the early stages of recovery, depending on the severity of the injury, pain medication like NSAIDs may be helpful. You don’t want NSAIDs to be the only tool you use for pain management. While NSAIDs can be helpful with reducing inflammation and helping with pain control, it is best to limit use. Not only do we want to limit long-term NSAID use, but newer evidence is suggesting staying away from NSAIDs altogether! Why? Because NSAIDs limit inflammation. There has to be some sort of inflammatory response from the body in the very early stages of injury. This is what kickstarts the recovery process. If you limit the inflammatory response, it could potentially suppress and/or delay the natural healing process.
Ice can be useful for both pain and swelling as necessary. It is more commonly used in the early stages of recovery. 10-15 minutes at a time is all you need and you can use it multiple times throughout the day.
Should I Use a Brace After Ankle Sprains?
An ankle brace should be used as a tool for a moment in time, but not be relied on for long-term use. Ankle braces provide some extra support to the ankle by limiting it’s range of motion and at the same time provide some movement to be able to move. They are great options for individuals looking to return to sport when they are first returning back to resuming practice and play. Once it is established that the ankle can withstand the demands of sport with the ankle brace on, you can start to limit how often you wear it during practice and/or games. It is not something you want to rely on in the long run. You don’t want to train your body to get used to wearing an ankle brace. Loading tissues is how they remain strong. If you are not completely loading the tissues because you are relying on the ankle brace the majority of the time, you will not be strengthening to your greatest potential. Braces are meant to be used for an amount of time, but should be discontinued in the long run.
Choosing the Right Footwear After a Sprained Ankle
Choosing the right footwear can be advantageous and beneficial. Supportive footwear will provide enough space within the toe box, provide arch support as necessary, and support the rest of the foot while also providing enough movement to keep the tissues and joints mobile. There is proper footwear for different types of activity.
A good supportive shoe for everyday activities and walking is one place to start. For individuals who enjoy hiking, wearing a hiking boot is more beneficial. It will provide extra support by lacing up around the ankle to prevent accidental ankle sprains from slipping or tripping on uneven terrain. Individuals playing sports such as baseball, soccer, and football should wear cleats that have added grip to the ground to support change of direction.
While picking the right shoe won’t fix all problems and prevent any injury from occurring, it is a great place to start. If you want to learn more about foot posture and picking the right footwear for you, check out my post here!
Other Related Articles on the Foot/Ankle
- What to Know About the Achilles Tear Recovery Time
- How to Fix Weak Ankles: The Ankle Support You Need
- Understanding the Connection Between Foot Posture and Back Health
- A Complete Guide to At-Home Bunion Treatment
- Managing Pain in the Back of the Ankle
- Ankle Pain When Walking? Why it Hurts and How to Fix It
- Pain When Walking First Thing in the Morning? Try These 7 Exercises for Plantar Fasciitis
References
1 Delahunt E, Bleakley CM, Bossard DS, et al. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. Br J Sports Med. 2018;52(20):1304-1310. doi:10.1136/bjsports-2017-098885
2 Hu X, Feng T, Li P, Liao J, Wang L. Bilateral Sensorimotor Impairments in Individuals with Unilateral Chronic Ankle Instability: A Systematic Review and Meta-Analysis. Sports Med Open. 2024;10(1):33. Published 2024 Apr 8. doi:10.1186/s40798-024-00702-y
3Solaiman RH, Dirnberger J, Kennedy NI, et al. The effect of nonsteroidal anti-inflammatory drug use on soft tissue and bone healing in the knee: a systematic review. Annals of joint. 2024;9:3-3. doi:https://doi.org/10.21037/aoj-23-58
TL;DR
A sprained ankle occurs when you stretch or tear the ligaments that provide support to your ankle and can vary by severity of the injury. Physical therapy for a sprained ankle helps not only to recover from the initial injury, but reduces your risk from recurring injuries. This post reviews the anatomy of the ankle, discusses what an ankle sprain really is, and goes over physical therapy exercises and other important advice on how to recover from a sprained ankle.
Tera Sandona is a licensed Doctor of Physical Therapy (DPT) and the founder of PT Complete. She helps high-achieving women break out of cycles of chronic pain, stress, and burnout through her Regulate and Rebuild Method, a sequenced approach that addresses the nervous system first and builds strength second. Her work focuses on helping women finally understand their bodies, rebuild strength, and create lasting resilience that fits real life.
