Ankle Sprain Rehabilitation Program

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A structured rehabilitation program is important for optimum recovery from an ankle sprain. We outline an example of a sprained ankle rehab schedule below for grade 1, 2 and 3 injuries. This rehabilitation program is intended as a guide only.

We strongly recommend seeking professional advice for a more effective rehabilitation program and the following is for information purposes only. All timelines are given as an indication only.

Grade 1 Ankle Sprain

A grade 1 ankle sprain results in mild symptoms with some pain and little or no swelling.

Stage 1: 0 – 72 hours post injury

Cold pack on foot

Protect the ankle from further injury by resting. An ankle support or ankle taping may be beneficial to prevent unwanted rolling of the ankle in the early stages whilst walking. Resting the ankle from dynamic activities such as playing sport or running is essential in this stage to allow healing to commence. Full weight bearing should be introduced as soon as pain allows but not before. Avoid sideways ankle movements which are likely to stress the injured ligaments.

Ice or cold therapy should be applied throughout the rehabilitation process. Apply ice for 15 minutes every hour initially for the first day then reduce this to 4 to 5 times a day from then on as required. Do not apply directly to the skin as this may cause ice burns. Using ice wrapped in a wet tea towel or a cold therapy compression wrap or cold pack can avoid this. In the acute stage ice will constrict blood vessels and prevent further bleeding. Longer term benefits include reduction of pain and muscle spasm. Ice should not be used for longer than 15 minutes as prolonged cooling has the reverse effect of increasing blood flow and long periods of cooling can also cause nerve injury. Ice therapy should be used throughout the rehabilitation process to control inflammation, but only in 15 minute sessions each time.

Compression will help reduce and prevent swelling and can be applied immediately after injury at pitch side but only for 10 minutes at a time to avoid cutting of circulation to the area. A tube grip or elastic ankle support can provide mild compression throughout the healing process to help reduce swelling. Elevating the ankle onto a cushion whilst laying down can help swelling drain away from the site of the injury and ideally, we advise elevating the leg and icing the ankle together.

Stage 2: Days 3 to day 7

If the ankle is feeling comfortable then start some of the ankle mobility exercises very gently, 3-5 times a day.  The exercises recommended would be active plantar flexion and dorsi-flexion.

Strengthening exercises including the resisted plantar flexion and dorsiflexion and isometric eversion and inversion. Electrotherapy such as ultrasound may be used at this stage and can be beneficial in reducing swelling and relaxing the muscle (always performed by a professional therapist).

Continue to rest from any aggravating activities. Continue with P.R.I.C.E, continue to wear a compression bandage or ankle support. Basic proprioception exercises can begin – standing on one leg (eyes open and eyes closed, arms out and in).

If you are being treated by a therapist, he/she may decide at this stage to use alternating hot and cold therapy to further improve healing and reduce swelling.

Stage 3: Day 8 +

A healing ligament does needs a certain amount of stress to heal properly so it is important that the rehabilitation process is progressive and slowly introduces stress to the ligament.  However, doing too much exercise or putting too much stress on the healing ligament in the early stages can be detrimental so this needs to be finely balanced.   Rehabilitation is both an art and a Science.

Continue with PRICE and plantar and dorsiflexion mobility exercises. Now introduce the active inversion/eversion exercise to improve the range of movement of he ankle and flexibility of the ligaments. Ankle massage (link) can be performed to improve the healing of the damaged ligaments. Begin more advance strengthening exercises such as resisted eccentric inversion (link) and calf raises (link).

More advanced proprioception exercises such as standing on an unstable surface (link) and hopping (link) can be commenced.  When hopping exercises are performed confidently then jogging can commence. Progress from jogging to sprinting in straight lines as long as the ankle remains pain free and does not swell up.

Finally introduce twisting and turning activities. The overall rehabilitation time frame for a grade 1 ankle sprain is between 2 and 4 weeks.  If the ankle is still swollen or painful after this length of time, then we definitely recommend seeking a professional opinion.

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Grade 2 Ankle Sprain

Grade 2 injuries results in symptoms of moderate to severe pain with severe difficulty on walking. The athlete is unlikely to be able to play on and will often limp heavily.

Stage 1: Day 0 - 7

Stirrup ankle brace

It is important to protect the ankle from further injury by resting it. Avoid excessive weight bearing (use crutches if necessary) and wear an ankle support (link) that allows forwards and backwards movement but not lateral/sideways movement. ankle taping can be used as an alternative to an ankle support but this does need replacing on a daily basis.

Rest from sporting activities is essential - a healing ligament needs a certain amount of stress to heal properly but overdoing it early on in the rehabilitation process can delay or even prevent healing. Full weight bearing should be introduced as soon as pain allows but not before.  Avoid sideways ankle movements which are likely to stress the injured ligaments.

Ice or cold therapy should be applied throughout the rehabilitation process. Apply ice for 15 minutes every hour initially for the first day then reduce this to 4 to 5 times a day from then on as required. Do not apply directly to the skin as this may cause ice burns. Using ice wrapped in a wet tea towel or commercially available cold pack can avoid this. In the acute stage ice will constrict blood vessels and prevent further bleeding. Longer term benefits include reduction of pain and muscle spasm. Ice should not be used for longer than 15 minutes as prolonged cooling has the reverse effect of increasing blood flow and long periods of cooling can also cause nerve injury. Ice therapy should be used throughout the rehabilitation process to control inflammation, but only in 15 minute sessions each time.

Compression will help reduce and prevent swelling and can be applied immediately after injury at pitch side but only for 10 minutes at a time to avoid stopping the circulation. A tube grip or elastic ankle support can provide mild compression throughout the healing process to help reduce swelling.
Elevation by raising the leg will help swelling drain away from the site of the injury. Elevate the leg while icing and for 10 minutes after.

Stage 2: Day 8 to 21

Continue with P.R.I.C.E. Continue to rest from any aggravating activities. Continue to wear a compression bandage or calf support. If the ankle is feeling comfortable then start some of the Ankle mobility exercises very gently, 3-5 times a day.  The exercises recommended would be active plantar flexion and dorsi-flexion.

Strengthening exercises (link) including the resisted plantar flexion and dorsiflexion and isometric eversion and inversion. Electrotherapy such as ultrasound may be used at this stage and can be beneficial in reducing swelling and relaxing the muscle – always performed by a professional therapist).

Basic proprioception exercises can begin – standing on one leg (eyes open and eyes closed, arms out and in - LINKS) If you are being treated by a therapist, he/she may decide at this stage to use alternating hot and cold therapy to further improve healing and reduce swelling.

Stage 3: Days 22+

A healing ligament does needs a certain amount of stress to heal properly so it is important that the rehabilitation process is progressive and slowly introduces stress to the ligament.  However, doing too much exercise or putting too much stress on the healing ligament in the early stages can be detrimental so this needs to be finely balanced.   Rehabilitation is both an art and a Science.

Continue with PRICE and plantar and dorsiflexion mobility exercises. Now introduce the active inversion/eversion exercise to improve the range of movement of he ankle and flexibility of the ligaments. Ankle massage (link) can be performed to improve the healing of the damaged ligaments.

Begin more advance strengthening exercises such as resisted eccentric inversion (link) and calf raises (link). More advanced proprioception exercises such as standing on an unstable surface (link) and hopping (link) can be commenced.  When hopping exercises are performed confidently then jogging can commence.

Progress from jogging to sprinting in straight lines as long as the ankle remains pain free and does not swell up. Finally introduce twisting and turning activities.
 The overall rehabilitation time frame for a grade 2 ankle sprain is between 4 and 8 weeks.  If the ankle is still swollen or painful after this length of time, then we definitely recommend seeking a professional opinion.

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Grade 3 injury

Ankle taping

This is very severe injury of the ankle and are often associated with other injuries and complications.  We strongly advise you seek a professional opinion before rehabilitating this severity of injury.

Stop playing and rest immediately. If you are concerned that there may be an associated injury, go straight to a Doctor or Hospital.  Once you have been fully assessed and allowed to progress rehabilitation, follow the same program as for a grade 2 injury with the following modifications;

Initially use crutches for assisted weight bearing and do not walk un aided until the ankle is pain free. Prolong the 1st stage of rehabilitation including P.R.I.C.E. and gentle mobility exercises plantar flexion and dorsi flexion only for the first 2 weeks and do not be tempted to progress.

The overall rehabilitation time for a grade 3 injury is 8 to 12 weeks with most taking at least 10 weeks to fully recover.

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