Ankle sprain

Ankle sprains account for 85% of ligament injuries to this joint.¹ It is one of the most common injuries in sports and daily life. Here's the good news: with proper care, most sprains heal completely. However, about 40% of people develop chronic instability if they don't properly treat their sprain.¹ This guide explains how to recognize a sprain, when to seek professional help, and how to optimize your recovery. As physiotherapists specializing in traumatic injuries, we daily support patients through their rehabilitation. For an overview of conditions affecting this region, consult our complete guide to foot and ankle pain.

What exactly is an ankle sprain?

An ankle sprain occurs when you stretch or tear the ligaments that stabilize the joint. Ligaments are fibrous tissues that connect bones to each other. A lateral sprain, which affects the outer ligaments, accounts for 85% of cases.¹

The ankle has three main outer ligaments. The anterior talofibular ligament (ATFL) is the most commonly injured. It resists when your foot turns inward. The calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL) complete this stabilization system.

Ligaments do not contract like muscles. They heal more slowly. Their role is to prevent excessive joint movements. Unlike Achilles tendon tears, ankle sprains primarily affect ligamentous structures rather than tendons.

How does an ankle sprain happen?

A sprain occurs when your foot twists beyond its normal range of motion. The most common mechanism is inversion, where your foot turns inward. This often happens when walking on an uneven surface or landing awkwardly after a jump.¹

Inversion movement causes 80% to 85% of ankle sprains. Eversion, where your foot turns outward, is less common. It injures the deltoid ligament on the inside of the ankle.

Common circumstances for a sprain include:

• Walking on uneven ground
• Landing awkwardly after a jump (especially during intense sports activities)
• Changing direction quickly in a sport
• Falling off a step or curb

Athletes who play sports involving repeated jumping, such as basketball or volleyball, are particularly at risk. These movements can also cause other injuries like patellar tendinopathy in the knee.

An important point: a sprain always results from a clear traumatic event. If your pain developed gradually without an accident, you likely don't have a sprain. In that case, it could be Achilles tendon tendinopathy or another chronic condition.

What are the different grades of ankle sprains?

Doctors classify sprains into three grades based on their severity. Grade I: mild stretch. Grade II: partial tear. Grade III: complete ligament rupture with joint instability.

Initial pain doesn't always reflect the severity. Some Grade III sprains hurt less because the tear also ruptures nerve fibers. A professional must evaluate your injury to determine the grade.

What are the symptoms of a sprain and how can you tell it apart from a fracture?

Typical symptoms include immediate pain after the injury, especially on the outside of the ankle. Swelling can appear quickly or within the following hours. You might also notice bruising, have difficulty walking, and feel instability.

Immediate symptoms include:

• Sharp pain at the time of injury
• Sometimes a 'pop' or cracking sensation
• Difficulty putting weight on the foot

Within the following hours, you might experience:

• Progressive swelling
• Redness and warmth (for about 48 hours)
• Bruising if ligaments have bled

A minor sprain might not cause visible swelling. Bruising can spread towards the foot due to gravity. If you feel pain under your foot, it could also indicate plantar fasciitis, especially if the pain is localized in the heel.

Your physiotherapist distinguishes a sprain from a fracture through a clinical examination and the Ottawa rules. They will assess if you need an X-ray. Specific bone pain, complete inability to walk, and severe swelling suggest a possible fracture.

You need an X-ray if you experience:

• Pain directly on the bone when touched
• Inability to take four steps
• Over 55 years of age

Go to the emergency room if you notice a visible deformity, experience extreme pain, or completely lose your mobility.

When to consult a physiotherapist for an ankle sprain?

Consult a physiotherapist as soon as possible after the sprain, ideally within the first few days. You can book an appointment for the same day without seeing a doctor first. The initial days are crucial for optimizing recovery.

You do not need a medical referral in Quebec. Access is direct. If your physiotherapist detects a complication, they will refer you to the appropriate professional. To learn more about the role of physiotherapy, consult our complete guide.

During your first consultation, your physiotherapist will:

• Assesses the severity of the sprain (grade I, II or III)
• Rules out the risk of fracture
• Establishes a tailored treatment plan

Consulting early helps you avoid common mistakes: too much rest or returning to activity too quickly. The first 48 to 72 hours are critical.

How does physiotherapy treat an ankle sprain, and is it effective?

Physiotherapy is recognized as an effective treatment for ankle sprains, with results supported by scientific research. Studies show an 80-90% success rate for treating ankle sprains with physiotherapy. The combination of therapeutic exercises, manual therapy, and education proves particularly effective in reducing pain and improving function.

The effectiveness of treatment depends on several factors: how early you seek consultation (earlier means better results), consistency with home exercises, the severity of the sprain, any remaining instability, and proprioception (your body's sense of position). A complete evaluation allows us to tailor the treatment to your specific situation. Most patients notice improvement within the first 1-2 weeks of sessions, with full recovery typically in 4-8 weeks.

Physiotherapy optimizes the healing environment. Your physiotherapist addresses factors that slow down recovery: improper activity levels, excessive fears, joint stiffness, and poor biomechanics.

Your body heals naturally. Inflammation is a normal and necessary process. Several factors can slow down healing:

• Concerns or fears
• Improper activity levels
• Joint or muscle stiffness

Think of a plant. You can't make it grow faster by pulling on it. However, you can give it enough water and sunlight. To better understand pain mechanisms and management, consult our guide on chronic pain.

Phase

Duration

Stability, return to function

Proprioception, functional exercises

Rehabilitation follows a structured progression in several phases, adapting the intensity and complexity of exercises based on your individual response and your goals for returning to activity.

Your physiotherapist will advise you on the use of crutches, a brace, or a bandage if needed. Discover how physiotherapy treats foot and ankle pain.

Do you have an ankle sprain? Book an appointment for a complete evaluation and a personalized treatment plan.

What exercises help heal an ankle sprain?

Proprioception and balance exercises are essential for a full recovery. They train your brain to better control your ankle. Proprioceptive training reduces the risk of recurrence by 35 to 50%.

Proprioception helps your brain know where your ankle is in space. Exercises on unstable surfaces and with your eyes closed gradually increase the difficulty. If you have previously experienced a calf strain, these balance exercises will also be beneficial in preventing recurrence.

Can You Treat an Ankle Sprain Yourself?

Self-treatment can relieve a mild ankle sprain (ice, rest, gentle stretches). However, without proprioceptive rehabilitation (training your body's sense of position), you risk chronic instability and recurring sprains. Without an accurate diagnosis, you risk maintaining compensatory movements or doing counterproductive exercises that delay healing.

The physiotherapist assesses ligament stability and trains proprioception to prevent recurrence. An evaluation helps identify the exact cause, rule out serious issues (red flags), and create a progressive treatment plan. Exercises are tailored to your specific condition, not generic.

Our approach: professional assessment + supervised home exercise program = better long-term results.

Are you hesitating between self-treatment and a consultation? Free 15-min consultation to discuss your situation.

How long does recovery take, and how can recurrence be prevented?

Healing time varies from 2 to 12 weeks depending on severity. A mild sprain (grade I) heals in 1 to 2 weeks. A moderate sprain (grade II) takes 3 to 6 weeks. A severe sprain (grade III) requires 6 to 12 weeks.

Several factors influence the duration:

• The severity of the injury (grade)
• The quality of your rehabilitation
• Your injury history

Do not base your return to sports solely on the absence of pain. Functional tests assess your strength, balance, and confidence. If you see no improvement after 10 days, consult a physiotherapist.

Healing times are comparable to other ligament injuries, but generally shorter than a meniscal tear or a fracture.

Complete your rehabilitation and perform regular proprioception exercises. Approximately 40% of people develop chronic instability after an improperly treated sprain.¹

Chronic instability makes the ankle feel like it "gives way" easily. This condition can lead to repeated sprains and premature arthritis, similar to the degenerative processes seen in knee osteoarthritis.

Effective prevention strategies:

• Complete your rehabilitation program fully
• Continue proprioception exercises after recovery
• Strengthen the muscles around the ankle, including the calf muscles which play a stabilizing role.
• Warm up properly before sports
• Wear appropriate shoes with good support

Taping or a brace can help with returning to sports. However, these aids do not replace exercises. For athletes, a gradual return is essential, similar to the rehabilitation needed after a knee sprain.

What are the key takeaways about ankle sprains?

Ankle sprains are serious but treatable injuries. With appropriate management and complete rehabilitation, you can regain a stable ankle and prevent recurrence. Seek consultation promptly, follow your exercise program, and do not stop it too soon.

Remember that 40% of people develop chronic instability without adequate rehabilitation. If you have suffered an ankle sprain, book an appointment with our team for a complete evaluation.

For other foot and ankle conditions, consult our guides on Morton's neuroma, bunions (hallux valgus), or metatarsalgia.

References

• Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.