Sprained ankle

What is a sprained ankle?

A sprained ankle, also known as a twisted ankle, occurs when your ankle rolls inward in an unnatural way. This is known as an inversion injury. During this movement, the lateral ankle ligaments on the outside of your ankle are stretched or torn. In most cases, the anterior talofibular ligament (ATFL) is injured, while more severe sprains may also damage the calcaneofibular ligament (CFL).

These ligaments normally stabilise your ankle during side-to-side movements. When they are injured, an inflammatory response develops, causing swelling, warmth, and pain. Your ankle may feel unstable, and putting weight on it can become difficult or impossible. Early treatment can speed up recovery and reduce the risk of long-term problems.

Common symptoms

The symptoms of a sprained ankle usually develop within minutes to hours after the injury. The more severe the injury, the faster and more intense the symptoms may become.

Common signs include:

• Immediate pain on the outside of the ankle after twisting it
• Visible swelling around the ankle
• Bruising or discolouration after several hours
• Warmth and tenderness around the injured area
• Difficulty standing or pushing off with the affected leg
• A feeling that the ankle gives way or feels unstable
• Reduced range of motion in the ankle joint

If you recognise these symptoms, it is important to have your ankle assessed in time. Early treatment can help prevent a sprained ankle from developing into chronic ankle instability.

Causes and risk factors

A sprained ankle most commonly occurs during sports, walking on uneven ground, or missing a step or kerb. Sports such as football, basketball, running, and trail running carry a higher risk due to rapid changes in direction and unpredictable surfaces.

Factors that increase the risk include:

• Previous sprains of the same ankle
• Reduced balance or proprioception
• Weak calf and lower leg muscles
• Inadequate warm-up before exercise
• Uneven surfaces or poor lighting
• Shoes with insufficient lateral support
• Fatigue during the final stages of training

Previous ankle sprains are one of the strongest predictors of a future injury. Although the ankle heals, the ligaments and sense of joint position do not always fully recover without targeted rehabilitation.

The three grades of a sprained ankle

Not every sprained ankle is equally severe. In sports medicine, ankle sprains are generally divided into three grades based on the amount of ligament damage.

Grade 1 involves mild stretching of the ligaments without tearing. Swelling and pain are usually mild, and weight-bearing is often still possible. Recovery generally takes one to two weeks.

Grade 2 involves a partial tear of one or more ligaments. The ankle is noticeably swollen and bruised, weight-bearing is painful, and function is reduced. Recovery usually takes four to six weeks.

Grade 3 is a complete rupture of one or more ligaments. The ankle is severely swollen, highly unstable, and weight-bearing is nearly impossible. Recovery may take two to three months or longer and requires intensive rehabilitation.

If you are unsure about the severity of the injury, especially after significant trauma or persistent bone pain, imaging such as an X-ray may be recommended to rule out a fracture. Physiotherapists often use the Ottawa Ankle Rules to determine whether imaging is necessary.

What you can do right away

The first 48 hours after a sprained ankle are important. Following the RICE principle can help control swelling and pain.

You can do the following yourself:

• Rest: Rest your ankle during the first 24 to 48 hours, but keep it gently moving within your pain limits
• Ice: Cool the ankle for 15 to 20 minutes several times a day
• Compression: Use an elastic bandage or ankle wrap to reduce swelling
• Elevation: Keep your ankle raised above heart level
• Avoid heat, alcohol, and heavy physical activity during the first few days
• Gradually increase weight-bearing based on pain rather than time

Avoid complete rest for too long. Early, controlled loading often leads to better recovery than prolonged immobilisation. This approach is also known as the POLICE protocol.

Assessment and treatment plan

During your assessment, we look beyond the swelling and pain. We also identify why the injury occurred and assess your risk of future ankle sprains.

Your assessment may include:

• Clinical tests to determine the severity of ligament damage
• Examination of swelling, bruising, and tenderness
• Assessment of ankle range of motion
• Stability testing while standing and walking
• Balance and proprioception testing
• Strength testing of the calf, lower leg, and foot muscles
• Walking and sports movement analysis

Based on these findings, we create a personalised treatment plan for your sprained ankle.

Treatment may include:

• Joint mobilisations to restore ankle and foot movement
• Targeted strength and balance exercises
• Advice on taping or using an ankle brace
• Guidance on gradually increasing activity levels
• Manual therapy for joint stiffness
• Supervised return to sports and daily activities

The goal is not only to reduce pain, but also to restore ankle stability and lower the risk of future injuries.

Rehabilitation phases

Phase 1 – Controlling pain and swelling

During the first phase, the focus is on reducing pain and swelling. Gentle movement exercises are started within pain limits to prevent stiffness. Complete rest may delay recovery.

Phase 2 – Restoring movement and strength

Once the acute phase has passed, we gradually restore mobility and strength through targeted exercises. These may include ankle mobility exercises, calf strengthening, and controlled weight-bearing on one leg.

Phase 3 – Balance and proprioception

This phase is essential for preventing future ankle sprains. Balance board and stability exercises help retrain your ankle to react quickly to unexpected movements. These reflexes are often impaired after a sprain.

Phase 4 – Returning to sports

Once your ankle is stable enough, we introduce jumping drills, changes of direction, and sport-specific exercises. Football players require different training stimuli than runners or dancers. This helps rebuild confidence so you can return to sports safely.

Prevention and reducing the risk of recurrence

One of the biggest risks after a sprained ankle is returning to sports too soon, before the ligaments and movement control have fully recovered. This increases the chance of another sprain.

Important prevention tips include:

• Continue balance exercises even after the pain has disappeared
• Wear an ankle brace or use tape during high-risk sports in the first few months
• Strengthen your calf and lower leg muscles
• Warm up properly before exercise, especially in cold weather
• Choose shoes with sufficient lateral support
• Pay attention to signs of instability, such as repeated minor giving way

An ankle that has been sprained more than once does not always return to its previous level without support. With targeted rehabilitation, however, the risk of future sprains can be reduced significantly.

Your next step

Do not continue walking around with a sprained ankle for too long. Professional guidance is especially important if swelling persists, the ankle repeatedly gives way, or pain continues. With a clear diagnosis and a targeted treatment plan, you can work towards a full recovery and help prevent chronic symptoms.