Experienced an ankle sprain? Fear not, they’re among the most common injuries experienced by active individuals. Whether you’re a competitive athlete or weekend warrior, the sudden twist or roll of an ankle can quickly sideline you from your favourite activities. This comprehensive guide will walk you through everything you need to know about ankle sprains – from what they are and how to manage them in the short term, to long-term rehabilitation strategies that help prevent chronic ankle instability.
What Is an Ankle Sprain?
An ankle sprain occurs when you roll, plant or twist your foot awkwardly, leading to overstretching or tearing of the ligaments surrounding the ankle joint. These injuries happen during various activities but are particularly common in sports that involve running, jumping, and rapid changes in direction.
Types of Ankle Sprains
Depending on how you roll your ankle, there are three different areas that can be injured:
- Inversion Sprains (Lateral)
- This is the most common type of ankle sprain
- Occurs when the ankle rolls outward
- The anterior talofibular ligament (ATFL) is affected in almost 75% of lateral ankle sprains
- Most people can successfully rehabilitate without surgery
- Eversion Sprains (Medial)
- Less common than lateral sprains
- Occurs when the ankle rolls inward
- Involves the ‘deltoid ligaments’ on the inner ankle
- The ankle’s anatomical structure and normal biomechanics make these injuries less frequent
- Suspected medial ankle injuries warrant professional guidance
- High Ankle Sprains (Syndesmosis)
- Typically more severe as they involve the ligaments binding the lower leg bones together
- Can occur with any ankle motion but usually result from significant external rotation or ankle dorsiflexion
- Important to rule out a lower leg fracture, as symptoms and mechanism can be similar
- Most can be treated non-operatively depending on severity
How Severe Is My Ankle Sprain?
Rehabilitation following ankle injuries can range from 1-12 weeks depending on severity. In some cases, an orthopaedic consultation may be necessary. If you’re ever in doubt after suffering an ankle injury, consult with a healthcare professional who understands your medical history, the mechanism of injury, and can provide an accurate diagnosis.
When to Seek Professional Input
Consider consulting a healthcare provider if:
- You meet the Ottawa Ankle Rules criteria (discussed below)
- Your symptoms fall into severe categories
- You have recurrent lateral ankle sprains (chronic ankle instability)
Ottawa Ankle Rules
These rules help determine if you might need an X-ray to rule out a fracture:
- Pain or bony tenderness over:
- Distal 6 cm of the posterior edge of fibula or tip of lateral malleolus
- Distal 6 cm of the posterior edge of tibia/tip of medial malleolus
- Base of the 5th metatarsal
- Navicular bone
- Inability to weight bear and take more than 4 steps due to discomfort
Grading Ankle Sprains
There are three levels of severity when you sprain an ankle:
- Grade 1 (Mild)
- Slight stretching and microscopic tearing of ligament fibres
- Mild tenderness and swelling
- Usually minimal loss of function
- Normal or slightly restricted movement
- Little or no bruising
- Some joint stiffness or difficulty walking
- Recovery typically takes 1-3 weeks
- Grade 2 (Moderate)
- Partial tearing of ligament
- Moderate pain, swelling and bruising
- Some joint instability
- Restricted movement
- Difficulty walking
- Recovery typically takes 3-6 weeks
- Grade 3 (Severe)
- Complete tear or rupture of ligament
- Severe pain, swelling and bruising
- Substantial joint instability
- Unable to bear weight or walk
- May require immobilisation and possibly surgery
- Recovery typically takes 6-12+ weeks
Severe sprains, regardless of location, typically require an orthopaedic opinion to ensure the highest quality of care.
Short-Term Management Of An Ankle Sprain
It’s much easier to manage a one-off ankle sprain than it is to rehabilitate chronic ankle instability. That’s why proper initial management is crucial.
The PEACE & LOVE Approach
Current evidence supports a PEACE & LOVE approach to acute ankle sprain management, replacing the outdated RICE method:
PEACE (first 1-3 days)
- Protection: Avoid activities that increase pain
- Elevation: Elevate the injured ankle higher than the heart when possible
- Avoid anti-inflammatories: Modern research suggests they may impair natural healing
- Compression: Use elastic bandage or taping to reduce swelling
- Education: Understand that the body knows best; avoid unnecessary passive treatments
LOVE (days 4+)
- Load: Let pain guide your gradual return to normal activities
- Optimism: A positive mindset helps condition the brain for optimal recovery
- Vascularisation: Choose pain-free cardiovascular activities to increase blood flow
- Exercise: Restore mobility, strength and proprioception through active rehabilitation
Key Recommendations for Short-Term Ankle Sprain Management
If you’ve sprained your ankle or think you might have:
- Use PEACE in the short term to assist healing
- Follow LOVE to guide the initial reloading of your ankle
- Maintain your fitness with off-feet options (rowers, bikes, etc.)
- Avoid weight bearing and walking for at least the first 48 hours after the initial injury
- Begin low-level aerobic activity within the next 2-5 days
Important note about ice and anti-inflammatories:
Avoiding ice and anti-inflammatory medications goes against what many of us were taught growing up and may still be advised by coaches and first aiders. A good rule of thumb is that if you can manage your pain without ice and anti-inflammatory medications, then don’t use them. Remember that swelling can contribute to pain, so elevating and compressing the area should be part of your pain management approach.
Benefits of Early Mobilisation
Early mobilisation (once you can bear weight without significant pain) is beneficial because it:
- Improves myofibrillar growth (ability to avoid scar tissue)
- Increases capillary growth (blood flow)
- Stimulates proprioceptive awareness
Research shows that prolonged immobilisation can double recovery time and decrease strength, so finding the right balance between protection and movement is key.
Long-Term Ankle Sprain Management: Avoiding Chronic Ankle Instability
The most important factor when rehabilitating ankle sprains is restoring proprioception as soon as possible (once you can weight bear pain-free).
Understanding Proprioception
Proprioception refers to your body’s ability to sense its position in space. Poor proprioception is like having laggy internet when playing a video game – by the time the information processes, it’s too late to act appropriately.
After an ankle sprain, it’s not only the ligaments that are affected. The sensory receptors in your ankle joint also sustain damage, making them less efficient at relaying information to your nervous system.
Here’s what happens:
- In a healthy ankle, these receptors quickly tell your nervous system when your ankle is rolling
- Your nervous system rapidly activates the appropriate muscles to correct the position before injury occurs
- After a sprain, there’s a delay in this communication process
- If not properly rehabilitated, this impaired proprioception persists
- With delayed muscular response, you’re unable to prevent subsequent sprains
- This cycle leads to Chronic Ankle Instability – repeated sprains that become increasingly easier to sustain
Comprehensive Rehabilitation Plan
To avoid chronic ankle problems, continue your rehabilitation with these three key goals:
- Focus on proprioception in early stages with bodyweight exercises
- Single leg balance exercises
- Foot clock exercises (imagining standing on a clock face and reaching your foot to different “times”)
- Single leg squats and stability work
- Ensure any mobility, strength or muscle discrepancies compared to the uninjured side are normalised
- Restore full range of motion in all directions
- Build calf and ankle strength to match the unaffected side
- Address any compensatory movement patterns
- Complete your rehabilitation in its entirety
- Don’t stop at basic exercises like calf raises and balance activities
- Progress to more dynamic movements:
- Jumping and plyometrics (pogos, hopping exercises)
- Straight-line running
- Change of direction drills
- Gradually advance to high-speed and unpredictable movement patterns
Remember that a comprehensive rehabilitation program progresses systematically from basic stability exercises to complex, sport-specific movements. The entire process may take several weeks to months, depending on the severity of your sprain, but complete rehabilitation is essential to prevent future problems.
Key Takeaways
- Ankle sprains vary in type and severity, with lateral (inversion) sprains being most common
- Follow the PEACE & LOVE protocol for optimal short-term management
- Restoring proprioception is critical for preventing chronic ankle instability
- Complete the entire rehabilitation process, progressing from basic exercises to complex movements
- Seek professional guidance if you meet any of the Ottawa Ankle Rules criteria or experience severe symptoms
By following these guidelines, you can recover effectively from ankle sprains and reduce your risk of developing chronic ankle problems. Remember: “If in doubt, reach out” to a qualified healthcare professional who can guide your recovery process.
