Ankle Sprain Treatment and Rehabilitation

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.

Home Self-Help Treatment

Home treatment starts by applying the PRICE principles to reduce pain, reduce inflammation and promote healing. This is then followed by mobilising exercises to regain movement and then strengthening the muscles to help support the ankle. Balance exercises (or “Proprioception” as it is known) are vital to ensure the ankle heals effectively and minimises the risk of re-injury.

Immediate treatment for a sprained ankle should involve P.R.I.C.E. (link to PRICE) (Protection, Rest, Ice, Compression, Elevation) and should be applied as soon as possible.

The PRICE principles are the gold standard treatment for treating acute sports injuries. The acronym stands stands for Protection, Rest, Ice, Compression and Elevation and should be applied as early as possible and continued for at least the first 24-72 hours.

Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively.

Rest is one of the most important components of the P.R.I.C.E principle, especially in the early stagers but is often neglected or ignored.

Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. Ice should only be applied for 15 minutes maximum and should always be wrapped in a cold towel to prevent ice burn.

Compression - applying compression to an injured area minimises the amount of swelling that forms after an injury in two ways and should be applied for the first 24 to 72 hours from the onset of injury.

Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4.

Read more on PRICE and how to apply it.

Taping and strapping for ankle sprains

Another very important treatment for ankle sprains is taping/strapping. Our resident expert Neal Reynolds teaches you how to tape your own ankle - ankle taping techniques video.

Taping plays an important role in the treatment of ankle sprains both in the early stages and in the later rehabilitation stages. During the first few days, compression bandages (link to neoprene ankle support) and ankle taping can be combined with the aim of reducing swelling and providing protection and support to the injured structures. During the rehabilitation stages taping is useful to support the injured structures in addition to “firing” up the muscles around the ankle (proprioception). Finally, taping of ankles can be useful in those that are recurrently injured by providing additional support whilst playing sport.

Professional Treatment

As mentioned above, for the most effective treatment and rehabilitation program we recommend you see a professional therapist. He/she will be able to accurately diagnose the injury and effectively treat the ankle to speed up the healing time and design a program to strengthen the ankle and design functional drills to effectively rehabilitate it.

One of the treatments that a therapist may choose to use is electrotherapy, such as ultrasound may be applied. This transmits high frequency sound waves into the tissues, which in the early stages can help with pain relief and to reduce swelling. In the later stages of rehabilitation, the ultrasound waves cause a micro massaging effect which can help stimulate blood flow into the muscle.

If you do consult your GP following an ankle injury they will usually refer you to a therapist and may prescribe anti-inflammatory medication e.g. ibuprofen which is beneficial in the first few days after the injury. Do not take ibuprofen if you have asthma and always speak to a pharmacist or doctor before taking medications. Taking medications is not the only answer to treating ankle sprains and caution is required. There is some evidence that anti-inflammatories can impair healing so do not take them for more than a few days at the beginning of the injury. Also, taking medication can sometimes "mask" any pain and may therefore be detrimental to the healing process.

Sports massage may be beneficial for treating a sprained ankle, particularly in the latter stages or for injuries that seem to take a long time to recover from. We have interviewed a soft tissue expert to demonstrate some simple self-help cross friction massage techniques that may be used to help align scar tissue on the ligaments for effective healing.

Play sports massage video for ankle sprains.

Rehabilitation program

An Example of a Detailed Rehabilitation Program for Mild (grade 1), Moderate (grade 2) and Severe Ankle (Grade 3) Sprains

A structured treatment 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 approximate and are given as an indication only.

Grade 1 Ankle Sprain

Stage 1: 0 – 72 hours post injury

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 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 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 pain is settling and the ankle is feeling comfortable then start some of the Ankle mobility exercises very gently, 3-5 times a day. The exercise 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 (see above). Continue to wear a compression bandage or calf 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 can be performed to improve the healing of the damaged ligaments.
  • Begin more advanced strengthening exercises such as resisted eccentric inversion and calf raises.
  • Start functional exercises
  • 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.

Grade 2 Ankle Sprain

Stage 1: Day 0 - 7

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 exercise 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).
• 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: 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 advanced strengthening exercises (link) such as resisted eccentric inversion (link) and calf raises (link).
• Start functional exercises
• 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.

Grade 3 injury

This is very severe injury of the ankle and are often associated with other injuries (complication link). 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 dorsiflexion (link) 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.