Sprained Ankle

Ankle sprain - Sprained ankle

A sprained ankle is one of the most common sports injuries. If you have suffered an ankle sprain then our rehabilitation program will get your back to full fitness as soon as possible.

Sprained ankle symptoms

  • You often know instantly if you have sprained your ankle.
  • Your foot turns inwards under the weight of your body, causing Instant pain.
  • Pain may be throughout the joint, or, specifically on the outside of your ankle where the damaged ligaments are located.
  • Your ankle joint may swell up immediately, or may sometimes take up to 48 hours to develop.
  • Bruising may also be visible over time.

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A comprehensive step by step ankle sprain rehabilitation program created by Senior England Rugby Team Physio Phil Pask

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How bad is my sprain?

Ankle sprains are graded 1, 2 or 3 depending on how bad they are:

Grades of ligament tear

Grade 1

A grade 1 sprain is a mild injury with some pain, but little or no swelling. Your ankle may feel stiff and you will have some difficulty walking or running. However, they will most likely be able to finish the training session or game. Ligaments are usually stretched rather than completely torn. They tend to recover relatively quickly, usually somewhere between 2 and 4 weeks.

Grade 2

Grade 2 ankle sprains cause moderate to severe pain. You will be unable to continue running and will probably find it very difficult to walk. Minor bruising and swelling may develop, either immediately, or over the following 48 hours. Your ankle will feel stiff and may feel unstable. This is because of torn ligament fibres. Recovery time for moderate grade 2 ankle sprains is usually between 4 and 8 weeks.

Grade 3

A grade 3 sprain is a complete, or near-complete tear of the ligament. You will have immediate, severe ankle pain and your ankle will feel very unstable and weak. Your ankle will swell up immediately, with bruising often developing over the following 48 hours. If you suspect you have a grade 3 sprain then you should seek medical attention as soon as possible. You will need an x-ray to rule out fractures. Severe ankle sprains can take up to 3 months to recover.

Sprained ankle assessment

A professional therapist or doctor will use a range of techniques to help assess your sprained ankle. These will include range of motion, palpation (feeling), resisted muscle tests and specific assessment tests. Special tests to assess damage to ankle ligaments include:

  • Anterior drawer test to assess the ATFL ligament
  • Talar Tilt to test the CFL ligament
  • External rotation and squeeze tests assess the high ankle ligaments (syndesmosis complex)

Tests which stress the ankle ligaments may be more reliable and valid if done 5 to 7 days after injury1.

Other injuries with similar symptoms

It is important to get an accurate diagnosis as other injuries and complications such as:

Ankle sprain causes & anatomy

Ankle Ligaments

The ankle is supported by a number of ligaments which connect bone to bone. The main ligaments involved in a sprained ankle are the tibiofibular and the calcaneofibular ligaments on the outside of the ankle.

Muscles on the inside and outside of the leg attach to the bones via tendons, also provide support and stability.

Inversion sprains vs eversion sprains

Types of ankle sprain - inversion and eversion

An inversion sprain is most common. This is where the ankle rolls outwards as the sole of the foot turns inwards. This, therefore, stretches or tears the supporting ligaments on the outside of the ankle.

An eversion sprain is less common and usually occurs in conjunction with a fracture of the fibula bone. As a result, the ankle rolls inwards flattening the foot and stretching ligaments on the inside of the ankle. Mild sprains may only damage one of the ligaments whereas a more severe sprain can damage two or more.

What causes a sprained ankle?

  • Poor proprioception is a leading cause of sprains, especially recurrent ankle sprains. This is your body’s awareness and ability to judge the position of body parts.
  • If you have ever started to turn your ankle over and reacted automatically to stop it, then this is proprioception at work.
  • Poor proprioception means the muscles would be less able to detect when the joint is at risk of injury, and therefore less able to correct the position of the ankle when needed. This can result in a sprain.
  • Previous injury and inappropriate footwear are also likely to increase your risk of a sprained ankle.

Ankle avulsion fracture & complications

An ankle avulsion fracture occurs when a tendon or ligament comes away from the bone often pulling a small piece of bone with it. The symptoms are similar to an ankle sprain, but unlike a sprain, an avulsion fracture pulls a piece of bone off when the ligament tears. An x-ray can determine which ankle injury you have and so how best to treat it.

Sprained ankle treatment

Cold pack over outside of the ankle

Treatment involves immediate first aid to reduce pain and swelling, rest to allow healing, followed by a rehabilitation program to restore full mobility, strength, and proprioception.

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A comprehensive step by step ankle sprain rehabilitation program created by Senior England Rugby Team Physio Phil Pask

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Self-help treatment

  • Apply the PRICE principles (protection, rest, ice, compression and elevation) as soon as possible after injury. It is important to rest the ankle to prevent further damage.
  • Apply ice wrapped in a wet tea towel to prevent ice burns, or better still a cold therapy and compression wrap will reduce pain, inflammation, and swelling.
  • Cold therapy can be applied for 10 mins every hour initially, reducing the frequency as symptoms improve. Elevating the ankle can also help reduce swelling by allowing tissue fluids to drain away.
  • Wear an ankle brace or support to protect the injured ligaments and provide compression. Initially, a simple elastic compression sleeve or support is ideal, whilst later in the rehabilitation process, a stronger brace with additional lateral support at the side may help protect the ligaments.
  • When pain allows, a full rehabilitation program of mobilizing, strengthening and finally functional or sports specific exercises should be performed.

Read more on our step-by-step ankle sprain rehabilitation program.

What can a professional therapist do?

  • A professional therapist can accurately diagnose your injury and give advice on treatment and rehabilitation.
  • They may use electrotherapy, such as ultrasound to help relieve pain, relax the muscles and reduce swelling.
  • Sports massage may be used to help reduce swelling in the acute stage and later cross friction massage directly to the ligament can help prevent scar tissue formation.

Sprained ankle taping


Taping for ankle sprains is used to both protect your injured ankle and improve confidence following injury. Tape can help support the damaged tissues in your ankle and activate the surrounding muscles. A professional therapist can tape your ankle, or you can try applying the tape at home by following the methods shown in our videos.

An expert will also be able to advise on rehabilitation exercises. Because they can assess the injury and where the damage has been done, they can recommend the best and most effective exercises for you to do. These exercises also involve strengthening the ankle and looking at any weaknesses that may have contributed to the injury. Performing these can help prevent any further injury in the future.

“People often say they have ‘weak’ ankles but in most cases, they have ankles that are in fact “poor proprioceptively” and not weak at all. Proprioception is by far the most effective treatment for treating and is the secret to preventing re-injuries in ankle injuries.”

Neal Reynolds, Sports Physiotherapist

Read more on rehabilitation of ankle sprains.

Exercises for a sprained ankle

Strengthening, mobility and proprioceptive exercises are important in the rehabilitation of ankle sprains.

Isometric exercises

Stretching and mobility exercises

Mobility exercises for the ankle can start very early in the rehabilitation process from day 2 in mild to moderate sprains. As a sprain can make the joint stiff, performing mobility exercises and stretches will help maintain normal range of movement.

Sideways movements should be avoided early on so as not to put any stress at all on the injured ligaments. Later, when pain allows, exercises with lateral movements involving sideways motion can be done.

Strengthening exercises

Ankle strengthening exercises can begin as soon as pain allows. Exercises that involve sideways movements should be avoided in the early stages to protect the healing ligaments. Isometric eversion and inversion exercises help to control the ‘rolling’ action of the ankle. This is especially helpful in preventing future injuries. A therapist or a friend can provide resistance, or you could use a wall.

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A comprehensive step by step ankle sprain rehabilitation program created by Senior England Rugby Team Physio Phil Pask

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Proprioceptive and functional exercises

One of the most important parts of ankle injury rehabilitation and in preventing re-injuries is proprioception. It is essential that proprioception exercises are included. These ‘fire up’ the muscles around the ankle joint to prevent injuries from reoccurring. Proprioception exercises include standing on one leg (which can be increased in difficulty by closing your eyes and standing on an unstable surface) to hopping (when pain allows).

As you increase the intensity, you can perform exercises with a more sports-specific focus. For example, doing lunges, step-backs, and jumps will help build up strength and the muscles until you are able to train fully. The intensity of the exercises should be increased slowly, it is important not to rush the process.

Read more and watch videos on ankle rehabilitation exercises.

References & further reading

  1. Cook CE, Hegedus EJ. Orthopedic Physical Examination Tests. 2nd ed. Upper Saddle River, New Jersey: Pearson Education Inc, 2013.
  2. Fong DT, Hong Y, Chan LK et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med 2007;37(1):73–94.
  3. Dimmick S, Kennedy D, Daunt N. Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI. J Med Imaging Radiat Oncol 2008;52(6):559–63.

This article has been written with reference to the bibliography.
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