Ankle Sprain

ANKLE SPRAINS

Ankle sprains are the most common sports injury, and physio treatment is all about getting you back to walking/running without it giving way again. Most are lateral sprains from rolling the ankle outward.

1. *Acute phase: first 48-72 hours*

Goal is to reduce swelling, pain, and protect ligaments while starting gentle motion.

- *Load management*: Walk as tolerated with crutches if needed. Complete non-weight bearing isn’t needed for most grade 1-2 sprains.

- *Compression & elevation*: Compression sock/bandage + elevate above heart level to control swelling.

- *Gentle range of motion*: Alphabet tracing with your foot, ankle pumps. Stiffness now leads to problems later.

- *Avoid*: Heat, alcohol, massage, and aggressive stretching in the first 48h - they increase swelling.

Grading matters: Grade 1 = mild stretch, Grade 2 = partial tear, Grade 3 = full tear. Most grade 1-2 heal well with conservative physio.

2. *Subacute phase: regain motion and strength*

Once you can bear weight without sharp pain:

- *Ankle mobility*: Dorsiflexion is key. Wall calf stretches, joint mobilizations if the talus is stuck.

- *Strength*: Resisted eversion/inversion, plantarflexion/dorsiflexion with bands. Peroneals are critical for lateral stability.

- *Calf strength*: Straight-knee and bent-knee calf raises. Weak calves overload the ligaments.

- *Proprioception*: Single-leg balance, eyes closed, unstable surfaces. This retrains the brain-muscle connection and prevents re-sprains.

3. *Functional phase: return to activity*

Start once you can single-leg balance 30s pain-free and walk normally.

- *Agility drills*: Figure 8s, lateral shuffles, cutting.

- *Plyometrics*: Hops, bounding, landing mechanics. Land soft, don’t collapse into the ankle.

- *Sport-specific drills*: Change of direction, jumping, cutting for your sport.

- *Gradual return to running*: Start with run-walk intervals, progress distance and speed.

4. *Why proprioception is non-negotiable*

Re-sprain rate is high if you skip balance work. The ligaments heal, but the nervous system needs retraining to react fast when you roll. 5-10 min of balance work daily for 6 weeks cuts re-injury risk significantly.

5. *What physios watch for*

- *High ankle sprain*: Pain above the ankle between tibia/fibula. Heals slower, needs more time off impact.

- *Chronic instability*: Ankle keeps giving way months later. Usually due to weak peroneals + poor proprioception. Some need bracing short-term.

- *Syndesmosis injury*: Different rehab, longer timeline.

What doesn’t help long-term

Rest, ice, compression, elevation only get you through week 1. Without strengthening and balance work, you’re likely to re-sprain. Ankle braces help short-term but don’t replace rehab.

Timeline

- Grade 1: 1-3 weeks

- Grade 2: 3-6 weeks  

- Grade 3: 6-12 weeks, sometimes longer

Most people return to sport too early and re-sprain. A good test: can you hop 10x on the injured ankle, single-leg balance 30s, and run pain-free? If yes, you’re close.

Is yours a fresh sprain or has it been rolling on you for a while? That changes whether we focus on acute swelling control or chronic instability.

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