A Physical Therapy Guide to Ankle Sprains
Also known as "rolling your ankle" or "twisting your ankle," ankle sprains are unfortunately all too common. According to a 2010 analysis of United States healthcare data, approximately 2 million ankle sprains occur each year.1
Unfortunately, many people with one ankle sprain go on to develop repeated sprains in the future, especially those who do not properly rehabilitate their injury.
Read more to learn about what happens within your body when you sprain your ankle, as well as what you can do to maximize your recovery.
- Understanding Ankle Sprains
- What Happens After an Ankle Sprain?
- What are the Most Common Risk Factors for Ankle Sprains?
- Diagnosing Ankle Sprains
- What to Expect from CityPT Physical Therapy
- Ankle Rehab for Performance and Reduced Risk of Re-Injury
- Preventing Ankle Sprains
- Is It Time to Seek Treatment?
A sprain occurs when one of your ligaments — a strong band of tissue that crosses a joint and connects two bones — is stretched beyond its capacity. You have several ligaments in your ankle. The type of sprain you have depends on the location of the ligament.
Lateral ankle sprain
With a lateral ankle sprain, you injure one or more of the ligaments on the outer part of your ankle. These ligaments span from the smaller outer lower leg bone (fibula) to the upper part of your ankle and foot bones (talus and calcaneus). This type of sprain occurs when your foot "rolls" inward. This is the most common type of ankle sprain.
Medial ankle sprain
A medial ankle sprain is less common, and occurs when your foot "rolls" outward. This type of sprain injures the ligaments on the inner side of your ankle which connect your the large bone in your lower leg (tibia) to the upper part of your ankle and foot bones (talus, calcaneus, and navicular).
High ankle sprain
A high ankle sprain, or syndesmotic sprain, occurs when your ankle and foot flex upward forcefully — often combined with turning inward or outward. This might occur when landing unexpectedly or awkwardly from a great height. The ligaments involved in this type of sprain are the ones which connect your tibia and your fibula.
At the moment of injury, you may or may not hear or feel a painful "pop." Immediately afterward, or within the next day or so, you may also begin to notice:
- Bruising or discoloration
- Tenderness to the touch
- Difficulty or inability bearing weight on that limb
- A feeling of instability, weakness, and/or stiffness
An ankle sprain occurs with a sudden and awkward movement when you plant your foot. We will review some factors that increase your risk
History of past ankle sprain: Having sustained an ankle sprain in the past can increase the risk of a future ankle sprain, with as many as 40% of people going on to develop recurrent ankle sprains.2
Body mass index (BMI): BMI has an unclear relationship with the risk for ankle sprains. Some studies show that a higher BMI increases the risk of ankle sprain. Others show that a lower BMI increases the risk.
Sports participation: Among the athletic population, the highest rates of ankle sprain occur among participants of sports that require running, cutting, or jumping, such as:
Daily life activities: Approximately half of people who report to the Emergency Department with an ankle sprain sustained their injury outside of sport.3 People who sprain their ankle outside of sport may have twisted their ankle unexpectedly on uneven ground. Or, they may have injured themselves when they stepped to the side off a curb, twisted awkwardly in high heels, or from falling on stairs. Although there is not a lot of research about specific occupations related to ankle sprain risk, some studies have identified a greater risk for:
- Certain tactical military roles.
Traditionally, ankle sprains have been categorized into three grades:
- Grade I is more of a stretch without major tearing or loss in function. You often experience minimal swelling and tenderness. These tend to heal quickest.
- Grade II involves a partial tear in the ligament with moderate swelling, tenderness, and loss in function.
- Grade III is a complete tear of the ligament with most pronounced loss of function, as well as the greatest swelling, bruising, and tenderness.4
Typically, ankle sprains can be diagnosed without imaging.
Your CityPT physical therapist will have you describe the details of your injury and the symptoms you have been experiencing in the days since.
A physical examination could include:
- Gentle palpation or pressing to determine where the pain is located
- Measuring of swelling and bruising
- Observing your walking and other movements
- Measuring your ankle range of motion and strength
- Performing special tests to determine if anything else is injured in the ankle or if you require further assessment or imaging
The initial phase of healing will focus on protecting your ankle from further injury. Your clinician will give you advice about:
- Guided activities to protect your healing ankle
- Compression and elevation to help decrease swelling
- If needed for pain relief, short (5 minutes or so) periods of applying ice.
Your CityPT physical therapist will also work with you to promote tissue healing during this initial phase of recovery including:
- Gentle manual therapy for swelling and joint motion, if applicable
- Gentle ankle exercises to promote blood flow and flexibility
- Cardio exercise—such as riding a stationary bicycle—to promote circulation to the healing area
- Progression to full weight bearing and normal walking during daily activities. Putting your weight safely through your injured limb actually helps with healing of the ligament.
Once the injured tissue begins to heal and pain and swelling return to near-normal, your CityPT therapist will help you introduce greater challenges. At this point the goal is to restore the ankle to its prior function, ideally even stronger, in the hopes of preventing re-injury or chronic ankle instability.
These higher intensity treatments may include:
- More intensive manual joint mobilizations and stretches to fully restore range of motion
- Sport- or work-specific exercises to target strength, power, and endurance
- Comprehensive training to improve your proprioception and balance
Progressive training for proprioception is particularly important for healing after an ankle sprain. Along with receptors in muscles, the receptors in the ligaments of your ankle give you awareness of what your body is doing in space. The information from these receptors is disrupted after an ankle injury. Therefore, proprioceptive and balance exercise, matched to your stage of healing, will optimize your recovery.
Remember, your ligaments continue to recover and remodel for up to a year or more after the initial injury. You may be recommended to wear a flexible brace for higher intensity training and during competition throughout this time.
What If Conservative Treatment Doesn't Work?
As mentioned above, your therapist will screen you at initial evaluation for any more serious injuries that might require further imaging or even surgery.
Generally people with an ankle sprain see good improvement in their pain and function without the need for invasive surgery.5
However, even after conservative management, some people continue with ankle difficulties which interfere with their sport, occupation, or daily life. In such instances, you may find it worthwhile to discuss further the pros and cons of surgery to repair the ligaments.
People who have had at least one ankle sprain in the past are at greater risk for a future ankle sprain.
Preventing these recurrent ankle sprains is an area of current research. There are several recent studies that show that working with a physical therapist after an initial ankle sprain can reduce the likelihood of it happening again.
Specific exercises targeting proprioception and power restore the body awareness and reactions necessary to train and compete at a high level.
Some athletes with repeated ankle sprains may also decide to wear a brace or ankle support during training and competition to help decrease the risk of re-injury.
In summary, if you recently sprained your ankle or have a history of multiple ankle sprains, then you would likely benefit from the expertise of a CityPT physical therapist. Research supports early rehabilitation with a physical therapist, athletes and everyone alike.
Book now with one of our experienced CityPT clinicians to get started.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92(13):2279-2284. ↩
Miklovic TM, Donovan L, Protzuk OA, Kang MS, Feger MA. Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction. Phys Sportsmed 2018;46:1, 116-122. ↩
Herzog MM, Kerr ZY, Marshall SW, Wikstrom AE. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train. 2019;54(6):603–610. ↩
Polzer H, Kanz KG, Prall WC, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia). 2012 Jan 2; 4(1): e5. ↩
Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018;52:956. ↩