Ankle Sprains

Understanding an Ankle Sprain: Causes, Treatment, and
Recovery

An ankle sprain is one of the most common musculoskeletal injuries, affecting people of all ages and activity levels. Whether it happens during sport, exercise, or simply stepping awkwardly, knowing how to manage it properly can make a big difference in recovery time and long-term outcomes.

What is an ankle sprain?

An ankle sprain occurs when the foot rolls inwards or outwards, causing the ligaments of the ankle to be stretched or torn. Ligaments are strong bands of tissue that connect bones and offer stability to the joints. This can lead to swelling, bruising around the ankle, as well as pain with weight bearing. Most sprains happen when the foot rolls inward (inversion injury), stretching and injuring the ligaments on the outside of the ankle.

If weightbearing is very painful immediately after an ankle sprain, an x-ray may be required to rule out a fracture first.

Common causes

Some common causes of ankle sprains include:

• Walking or running on uneven surfaces
• Wearing unstable footwear
• Poor balance or muscle weakness
• Sports or activities that involve jumping, pivoting, or sudden direction changes (e.g.,
  basketball, netball, dance)
• Contact or collisions during sports

Signs and symptoms

Symptoms can vary depending on the severity of the injury, but often include:

• Pain around the ankle
• Swelling and bruising
• Difficulty walking or bearing weight
• Reduced range of motion
• A feeling of instability

Types of Ankle Sprains

Ankle sprains are classified by the ligament complex involved and the mechanism of injury:

• Lateral sprain (most common):
  Occurs with an inversion injury, when foot rolls inward. The most affected ligament is the anterior talofibular ligament (ATFL), followed by the calcaneofibular ligament (CFL), and in more severe cases, the posterior talofibular ligament (PTFL). These injuries are frequent in running, jumping, and change-of-direction sports.
• Medial sprain (deltoid ligament sprain):
  Results from an eversion injury mechanism, where the foot rolls outward. This involves the fan-shaped deltoid ligament complex on the inner side of the foot. As this complex is stronger, these sprains are less common and often associated with higher-force injuries or fractures.
  
• High ankle sprain (syndesmotic):
  Involves the ligaments that stabilise the joint between the two shin bones, the tibia and fibula. The main ligaments involved include the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane. Typically caused by twisting injuries, these sprains often require a longer recovery period.

Grades of ankle sprains

Ankle sprains are typically classified into three grades:

Grade I (mild): Ligament fibres are stretched, with minimal tearing. There may be mild swelling and tenderness, and usually little to no joint instability. Often after the injury, weight bearing is possible with minimal pain. Recovery usually takes 1-2 weeks.

Grade 2 (moderate): Ligaments are partially torn. There is often moderate pain, swelling, and bruising. Some joint instability may be present, along with reduction in range of movement. Weightbearing can be quite painful, and a limp may be present. Recovery can range from 3-6 weeks.

Grade 3 (Severe): Ligaments are completely torn, meaning that are unable to hold the joint together, making the ankle feel loose or unstable. There is often significant swelling, bruising and tenderness, and weightbearing is very difficult. The recovery timeline for a grade 3 sprain varies and can take several weeks to months. Surgical intervention may be required, along with structured rehabilitation.

It is important to keep in mind that recovery varies depending on severity and is often influenced by personal factors such as age, activity level, general health, and previous injuries.

Returning to sport too early is one of the main reasons people re-injure their ankle, so proper progression is key.

What should you do after an ankle sprain?

Early management is important. The current best-practice approach focuses on RICER.

RICER (Rest, Ice, Compression, Elevation, Referral) is a simple, effective framework for managing acute ankle sprains in the first 48–72 hours.

Rest
Avoid painful activities and excessive weight-bearing in the first 24–72hrs. Crutches may be used if walking is very painful. While rest is a priority, complete immobilisation should be avoided. A physiotherapist can guide you through gentle early-stage exercises to maintain ankle range of motion and support healing.

Ice
Apply for 15–20 minutes every 2–3 hours to reduce pain and provide short-term symptom relief. Always wrap ice in a towel or cloth to prevent cold injuries to the skin.

Compression
Use an elastic bandage or ankle sleeve to manage swelling and provide support to the ankle joint. Ensure that the bandage is not restrictive to maintain comfort and circulation in the foot.

Elevation
Keep the ankle elevated above heart level to reduce fluid build-up at the site of injury and aid fluid return, to manage swelling and symptoms.

Referral

Seek physiotherapy or medical assessment if weightbearing is not possible, swelling is severe, or symptoms do not improve within 3-5 days.

Why physiotherapy matters

Many people assume ankle sprains will heal on their own, but without proper rehab the ankle often doesn’t regain full strength, control, or stability.

This can increase the risk of:

• Recurrent sprains
• Chronic ankle instability
• Ongoing pain, stiffness, or weakness
• Physiotherapy helps ensure the ligament heals properly and that the surrounding muscles and joints are working effectively again.

A physiotherapist can:

• Assess the severity of your injury and identify which structures are involved
• Manage pain and swelling in the early stages to support healing
• Provide soft tissue massage to help with symptom management and pain relief
• Restore guided range of motion exercises so the ankle can move normally again
• Provide tailored strengthening exercises to rebuild support around the joint
• Improve balance and proprioception (your body’s awareness of its position in space) to reduce reinjury risk
• Guide a safe return to activity or sport with gradual progressions

Targeted rehab not only speeds up recovery but also helps prevent long-term issues and
keeps you active with confidence.