Sprained Ankle

Ankle sprain - Sprained ankle

A sprained ankle is one of the most common sports injuries. Here we explain the symptoms, causes and treatment for ankle sprains as well as potential complications which are often missed.

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

A professional therapist will perform a number of assessment tests to help diagnose how bad your injury is. These include the talar tilt test and the anterior drawer test.

Similar injuries and complications

It is important to rule out other injuries or complications which may occur with a sprained ankle and are often missed. These include:


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?

A number of factors may increase your risk of a sprained ankle:

Poor proprioception

Proprioception is your body’s awareness and ability to judge the position of body parts and is a leading cause of sprains, especially recurrent injuries.

“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 the secret to preventing recurring ankle injuries.”

Neal Reynolds, Sports Physiotherapist

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 your joint is at risk of injury, and therefore less able to correct its position of the ankle when needed. This is why proprioception and balance exercises are an important part of rehabilitation.

Inappropriate footwear

Using the wrong type of shoes for your sport or activity can also increase your risk of a sprained ankle. Make sure shoes fit and are designed for your activity.


Treatment involves immediate first aid PRICE principles (protection, rest, ice, compression and elevation) following by a full rehabilitation program.

Cold therapy & compression

Apply ice or preferably a cold therapy compression wrap as soon as possible after injury to reduce pain, inflammation, and swelling. If you are using ice make sure it is wrapped in a wet tea towel to avoid ice burns.

Cold therapy can be applied for 10 mins every hour initially, reducing the frequency as your symptoms improve. Elevating the ankle helps reduce swelling by allowing tissue fluids to drain away from the site of injury.


It is important to rest. If you continue to walk or run on an injured ankle you run the risk of it becoming worse. It is much easier to cure a recent injury than it is a long term chronic one.

Wear an ankle brace

ankle brace buy online

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.


A professional therapist may use electrotherapy, such as ultrasound to help relieve pain and reduce swelling. Ultrasound transmits high frequency sound waves into the tissues for a micro massage effect.

Sports massage

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 supports the damaged tissues in your ankle and activates the surrounding muscles.

See a sports injury professional

A professional therapist can accurately diagnose your injury and give advice on treatment and rehabilitation. This is essential if you have a severe injury, or one that is not responding to treatment.

Rehabilitation & exercises

Ankle sprain rehab

When pain allows, a full rehabilitation program which includes mobility, strengthening, proprioception and functional (sports specific) exercises.

Our ankle sprain program has been created by England & British Lions Rugby physio Phil Pask and is based on what he would do with his elite players but adapted to suit all levels.

It consists of 4 phases and is criteria based rather than timeline, so you need to reach each phase’s exit criteria before moving onto the next.

We explain the treatment and exercises needed to get you back to full fitness including mobility, activation, movement control, strengthening and functional exercises.

Sideways movements should be avoided early on so as not to put any stress at all on the injured ligaments.

References & further reading

Ankle Sprain Rehabilitation Program

Our step by step rehabilitation program takes you from initial injury to full fitness.

Iphone app

We recommend the following products for treating ankle sprains:

Cold wrap

Cold compresion wrap

A cold therapy and compression wrap is essential first aid. It reduces pain and swelling and can also be used to apply heat later in the rehabilitation program.

Resistance bands

Resistance bands are important for most sports rehabilitation and enable you to exercise any muscle from the comfort of your own home.

Foam roller

A foam roller is an excellent piece of kit which can be used in place of massage to treat calf injuries. They are also excellent when use regularly as part of your warm up to help prevent future injury and improve performance.

Ankle support

Ankle brace

Ankle supports protect your ankle following injury and give support when returning to full fitness. Some have additional support at the sides to prevent sideways movement of the joint.

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This article has been written with reference to the bibliography.
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