Ankle Sprain Rehabilitation Guide
A comprehensive guide to recovering from an ankle sprain, from immediate injury care through return to activity. Most ankle sprains heal well with proper rehabilitation.
Understanding Your Ankle Sprain
An ankle sprain occurs when you roll, twist, or awkwardly turn your ankle, stretching or tearing the tough bands of tissue (ligaments) that help hold your ankle bones together.
The Most Common Sprain: Inversion
About 85% of ankle sprains are inversion injuries—rolling the ankle outward so the sole of the foot faces inward. This damages the ligaments on the outer (lateral) side of the ankle, primarily the ATFL (anterior talofibular ligament). Less commonly, eversion injuries damage the inner (medial) ligaments.
Sprain Grades
Understanding Your Results (grade)
Microscopic tearing. Mild pain, minimal swelling, minimal disability. Can bear weight with minimal discomfort. Recovery: 1-2 weeks.
Partial ligament tear. Moderate pain, swelling, bruising, difficulty bearing weight. Some instability. Recovery: 3-6 weeks.
Complete ligament tear. Severe pain, swelling, bruising. Cannot bear weight. Significant instability. Recovery: 6-12 weeks.
Immediate Care: Days 1-3
The R.I.C.E. Protocol
First 72 Hours: What To Do
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Recovery Timeline
Week 1: Protection & Early Motion
Week 1 Exercises
Ankle alphabet:
- Move ankle to trace letters of the alphabet
- Use full range of motion
- Perform 2-3 times daily
- Improves mobility in all directions
Gentle towel pulls:
- Loop towel around forefoot
- Gently pull toes toward you
- Hold 5 seconds, repeat 10 times
- Improves range of motion
Heel slides:
- Sit with affected leg extended
- Slide heel toward buttock by bending knee
- Keep heel on surface throughout
- Repeat 10 times, 2-3 times daily
Strengthening Exercises
Resistance band eversion/inversion:
- Sit with leg extended
- Loop resistance band around foot
- Move ankle against resistance in all directions
- 3 sets of 10-15 reps, 2 times daily
Calf raises:
- Stand on edge of step or sturdy platform
- Rise up on toes, slowly lower below step level
- Start with both feet, progress to single leg
- 3 sets of 10-15 reps
Towel scrunches:
- Place small towel on floor
- Use toes to scrunch towel toward you
- Works foot intrinsics
- 3 sets of 15-20 reps
Balance Training
🔬Proprioception: Why Balance Matters
Ankle sprains damage proprioceptors—nerves that tell your brain where your ankle is in space. This is why sprained ankles are easily re-injured.
Balance progression:
- Week 2: Stand on surgical leg near wall for support, 30 seconds
- Week 3: Progress to 60 seconds without support
- Week 4: Use unstable surface (foam pad, balance board)
- Week 5+: Add arm movements, eyes closed, or catch ball
Why this matters: Balance training re-trains proprioception, dramatically reducing re-injury risk. Don't skip this phase!
Return to Activity
Running Progression
Return to running when you meet ALL criteria:
- Full, pain-free range of motion
- No swelling with activity
- Normal walking without pain
- Single-leg balance ＞30 seconds
- Able to hop on surgical leg without pain
Running progression:
- Week 1: Walk-jog intervals (1 min walk, 1 min jog × 5)
- Week 2: Continuous jogging 10-15 minutes
- Week 3: Add speed, incorporate direction changes
- Week 4+: Return to normal training
Stop if: Pain increases, swelling returns, or you develop a limp
Sports-Specific Movements
- Week 3-4: Straight-ahead running
- Week 4-5: Cutting and pivoting drills
- Week 5+: Sport-specific movements
- Week 6+: Full return to sports
Prevention of Re-Injury
Preventing Future Ankle Sprains
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Red Flags: When to Seek Help
These Need Medical Evaluation
- Inability to bear weight 4+ hours after injury - Possible fracture
- Severe swelling or deformity - Requires X-ray
- Numbness or tingling - Possible nerve involvement
- Pain preventing sleep - May indicate significant injury
- No improvement after 2 weeks - May need imaging or different approach
Ottawa Ankle Rules (when X-ray is needed):
- Bone tenderness at posterior edge of lateral malleolus OR
- Bone tenderness at posterior edge of medial malleolus OR
- Inability to bear weight immediately and in emergency department
Frequently Asked Questions
References
References
- [1]American Academy of Orthopaedic Surgeons (AAOS). Ankle Sprain Treatment. 2023. https://www.aaos.org/
- [2]International Ankle Consortium. 2023 Consensus Statement on Ankle Sprain. Br J Sports Med. 2023. https://doi.org/10.1136/bjsports-2022-106871
- [3]Doherty CL, et al. Treatment and Prevention of Acute Ankle Sprain. British Journal of Sports Medicine. 2023. https://doi.org/10.1136/bjsports-2022-106534
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.