Ankle sprain: what to do and how to rehab it

What an ankle sprain is

An ankle sprain is an injury to one or more ligaments, the tough bands that connect bones to each other. The most common type happens when the foot rolls inwards, stretching or tearing the ligaments on the outside of the ankle. It might be a misstep off a kerb, landing on someone's foot in five-a-side, or rolling an ankle on a trail run.

Sprains are graded from mild (stretched fibres) to severe (a complete tear). Less commonly, the ligaments just above the ankle joint that bind the two shin bones together are injured. These high ankle sprains usually happen with the foot twisting outwards and tend to take longer to recover.

Ankle sprains are one of the most common sporting injuries, and they are often treated as minor. That is part of the problem: many people rest until it stops hurting, skip the rehab, and end up spraining the same ankle again months later.

Symptoms, and do you need an X-ray?

• Pain on the outside of the ankle, often just in front of and below the ankle bone
• Swelling and bruising, which may spread into the foot over a few days
• Pain putting weight through the foot
• Stiffness and difficulty moving the ankle
• A feeling of instability or the ankle giving way

Emergency departments use simple rules to decide who needs an X-ray. As a guide, get checked at A&E or an urgent treatment centre if you cannot take four steps on the foot, both straight after the injury and when you are seen, or if there is tenderness when pressing on the bony back edge or tip of either ankle bone, the bone on the outside of the midfoot, or the bone on the inside of the midfoot.

A sprain can also be confused with an Achilles tendon injury or a fracture at the base of the fifth metatarsal, which is the long bone on the outside of the foot. If in doubt, get it checked.

What a physio assessment looks at

Your physio will check whether you need an X-ray, then assess swelling, movement, ligament stability, strength and balance. They will test the high ankle ligaments and the Achilles tendon, and look at how you walk, hop and balance on one leg as the ankle recovers.

They will also ask about previous sprains. Repeated sprains on the same side, or an ankle that keeps giving way, suggest ongoing instability, which needs targeted balance and strength work rather than just waiting for it to settle.

A physio can also help with the practical side: when to stop using crutches, whether a brace is useful for your sport, and how to modify training so you can keep lifting and conditioning while the ankle heals. Seated upper-body work, core training and later cycling are usually possible within days.

What to do in the first few days

For the first two to three days, protect the ankle, manage swelling and keep it gently moving. That usually means walking as normally as pain allows, using crutches briefly if you need them, wearing a supportive shoe or brace, and raising the foot above heart level when resting. Compression can help with swelling, and ice can help with pain; our guide to heat or ice for an injury explains the options.

Research consistently shows that early movement and weight-bearing, often with a brace for support, give better results than immobilising the ankle for weeks for most sprains. Pain relief can help you keep moving; speak to a pharmacist or GP about what suits you.

Rehab: rebuilding strength and balance

1. Range of movement: ankle circles, alphabet tracing and gentle calf stretches, several times a day.
2. Strength: calf raises on both feet, then single leg, 3 sets of 10 to 15; band exercises pushing the foot out, in, up and down.
3. Balance: stand on one leg for 30 seconds, then with eyes closed, then on a cushion, 3 to 5 times each side.
4. Dynamic control: step-downs, lunges, hops on the spot and side-to-side hops as pain allows.
5. Sport-specific: running, cutting, jumping and landing, building up gradually.

Balance training is not optional. Research shows that a structured balance and proprioception programme reduces the risk of spraining the ankle again, which is one of the biggest problems after a first sprain. Keep doing it for several weeks after you feel normal.

You can often keep training the rest of your body while the ankle recovers: upper-body sessions, seated work, and later cycling or rowing if they are comfortable. Our guide to returning to running after injury covers the running stage.

Recovery time and when to get help

Mild sprains often settle within 1 to 3 weeks, moderate sprains within 3 to 6 weeks, and severe sprains or high ankle sprains can take several months. Some people are left with ongoing pain or instability, which usually responds to targeted rehab. The on-site physio at Lycan Strength can guide your rehab, with 20% off for members; book a physio appointment online.

• Go to A&E or an urgent treatment centre if you cannot take four steps, have bony tenderness, or the ankle looks deformed.
• Call 999 or go to A&E if the foot becomes cold, pale, numb or tingling, or pain is severe and increasing.
• Go to A&E the same day if you felt a kick or snap at the back of the heel and cannot push off.
• Call NHS 111 or see a GP urgently for a swollen, warm, painful calf. Call 999 with chest pain or breathlessness.
• See a GP or physio if the ankle keeps giving way or is not improving after a few weeks.

Questions