How do I manage my ankle sprain?

Written by:

Philippe Paradis

Scientifically reviewed by:

Ariel Desjardins Charbonneau

Download the article as a PDF

You just twisted your ankle, and now it’s swelling right before your eyes. You’re not sure whether you should apply ice, put on a bandage, or if you can walk on it. This situation is stressful, especially when you’re afraid of making the injury worse by doing something wrong.

Good news: Most people respond well to nonsurgical treatment for ankle sprains.^{1, 2, 3, 4} Complete rest is not recommended; on the contrary, early and gradual mobilization speeds up recovery.^{4, 5}

What science teaches us about ankle sprains:

Taking a few steps is not enough to rule out a fracture. Severe pain in a bone or the inability to take a few steps requires prompt evaluation.
Gentle movements and exercises started early—depending on the severity of the sprain—help restore function to the^{ankle.⁴, ⁵}
Anti-inflammatory medications can relieve pain, but they come with risks. Talk to a pharmacist or doctor about using them⁴
Ankle stability may remain reduced for several weeks. A return to normal activities depends not only on the number of days that have passed, but also on strength and balance.

10 Quick Tips to Understand Your Pain

One tip a day for 10 days to help you better understand your pain. About a 2-minute read.

This article provides guidelines for each stage of your recovery. The days listed are not strict deadlines: a severe sprain may take longer to heal. The instructions you receive after your evaluation take precedence over this timeline. To understand the modern approach to sprains, check out our article on PEACE and LOVE.

See also our comprehensive guide to ankle sprains and our explanations on ligaments.

A splint or adhesive bandage to support the ankle, combined with exercises, helps promote a better recovery. At first, keeping the ankle still for a short time can relieve pain and swelling.⁴

To learn more about this approach, visit our page on taping.

What to do immediately after a sprain?

Protecting the ankle and checking for warning signs are the first steps to take after a sprain.

Sudden pain can be frightening and prevent you from moving. Take a moment to breathe and examine your foot. Go to the emergency room if your foot is misshapen, cold, blue, or numb after the injury. Severe or worsening pain, significant swelling, or an inability to walk even a few steps also require prompt evaluation. The NHS describes these warning signs.

If these signs are not present, you can gently try the following steps, without using force:

Gently wiggle your toes
Touch your toes and foot to see if the sensation is normal
Make small movements with your ankle, within your comfort zone

Easy movement and a normal sensation are encouraging signs. However, these signs do not allow for a diagnosis of a sprain or rule out a fracture.

A severe lateral sprain may require prescribed immobilization for a short period—usually up to 10 days—before resuming exercise. A fracture or other injury may require different instructions. Do not remove prescribed immobilization without following your healthcare professional’s plan.⁴

If the instructions you’ve received allow for weight-bearing, first place your foot on the ground gently. Then shift some weight onto it while holding onto a stable support. Early exercises are part of the^recommended rehabilitation^{plan⁵, ⁴}. Don’t force yourself to take a few steps: your ability to walk is part of the evaluation, along with bone pain.

A prompt evaluation is necessary if you cannot take a few steps or if a bony prominence is very painful. The healthcare professional determines whether an X-ray is warranted, particularly using the Ottawa guidelines for the ankle and foot. Fear may limit weight-bearing, but it should not be used to explain an inability to walk without an examination.

What should you do during the acute phase—the very first few days after the sprain?

Care during the first few days combines protection, relief, and a gradual resumption of permitted movements.

For this phase, here are the important elements:

Limit activities that increase pain.
If cold relief helps, apply a cold pack wrapped in a cloth for no more than 20 minutes. Remove it if it becomes uncomfortable; do not apply it directly to the skin.
Continue with the comfortable activities and movements that were permitted after the evaluation. Severe swelling warrants a doctor’s visit, even if you can still take a few steps.
Ask your pharmacist or doctor for advice before choosing a medication. Anti-inflammatory drugs may provide relief, but they are not suitable for everyone. Do not stop taking a prescribed medication without consulting your doctor. See also our article on treating sprains.
A compression bandage can provide support for the ankle. Have someone check that it fits properly: the foot should retain its normal color and sensation.
Elevate your foot on a pillow when you are sitting or lying down

What should be done during the subacute phase, starting on day 2?

Gentle movements and gradual weight-bearing can begin as early as the first few days if your ankle can tolerate them and if there are no instructions prohibiting them. Day 2 is a possible guideline, not a requirement. Try the following activities without increasing the pain:

Start putting weight on your foot again while standing facing a stable counter
Walk in small steps near a stable table or counter, using it for support if needed
While at rest, gently raise and point your foot. Add inward and outward movements only if they feel comfortable and are permitted in your care plan.
Engage in physical activity that gets your heart pumping without worsening your symptoms, within your tolerance level. For example:

Ride a stationary bike if the motion feels comfortable. If you need to adapt the exercise to use only one leg, have your physical therapist check the position and stability of the machine.

Swim without using your legs, using an appropriate flotation device, provided that access to the pool is safe and your guidelines allow swimming

Exercises performed during recovery—particularly proprioceptive training that improves balance and ankle control—can reduce the risk of another sprain. For athletes who have previously suffered a sprain, the journal estimates the risk of recurrence to be 64% of that observed without such training, representing a relative reduction of 36%. This finding pertains to the exercise program, not a^mandatory start date6^{, 4}.

During this phase, monitor your pain, swelling, and gait. Reduce the duration or intensity of your exercises if your symptoms worsen during or after activity. Seek advice if this reaction persists.

What exercises should you do on days 2 through 7?

Support and balance exercises help you resume walking during the first week. Begin these exercises once the movements from the previous step feel comfortable and you are allowed to bear weight. Stand in front of a sturdy counter so you can hold onto it if needed:

Stand briefly on the injured leg, using your hands for support if necessary
Stand on the tips of both feet while holding onto the counter
Bend your knees slightly, as if you were about to sit down
Practice walking without limping, taking smaller steps if necessary

What can you expect from days 7 through 14?

Pain and walking ability often improve during the first two weeks. However, a severe sprain may heal more slowly. If the previous exercises feel comfortable, you can increase their difficulty:

If you are no longer limping, gradually increase the distance you walk. Otherwise, stick to short distances.
Walk up and down stairs without limping, holding onto a handrail. Gradually reduce your reliance on the handrail as your balance improves.
Stand on your injured leg near the counter, then gently turn your head from side to side to increase the difficulty.

What should you do during weeks 2 through 8?

Strength, balance, and sports-specific exercises will help you resume your activities between weeks 2 and 8. Your ankle may still lack stability at this stage. Continue progressing at a pace that suits your abilities and your rehabilitation plan, even if the pain subsides.

After an initial sprain, certain symptoms may persist. A meta-analysis of 15 studies estimates that the sensation of instability persists in 37.9% of people after three months, 16.1% after six months, and 8.1% after twelve months. Persistent pain affects 48.6%, 21.5%, and 6.7% of people at those same time points, respectively. Recurrences occur in about 15.8% of people during the first year. These averages are based on different groups and do not predict your^{personal outcome⁷, ⁴}.

A trial involving 522 athletes evaluated eight weeks of balance exercises added to standard care. A new sprain was reported by 22% of the exercise group, compared with 33% of the control group during the following year. This program supports continued exercise to prevent recurrences. See the study by Hupperets and colleagues.

Your physical therapist will then tailor the exercises to the demands of your sport or job. Comfortable walking and the previous exercises, which you have tolerated well, will help prepare you for the next steps:

Walking on uneven terrain, gradually increasing the difficulty
Jumping (with two legs first, then with one leg).
Running.
Squatting or kneeling.
Movements specific to your sport or job

If the pain remains difficult to manage, if fear is limiting your exercises, or if your ankle isn’t getting better, see a physical therapist. A significant worsening of symptoms or any of the warning signs described above requires prompt medical evaluation.

Need professional advice?

Our physical therapists can assess your condition and provide you with a personalized treatment plan.

Make an appointment

Sources

Links open in a new tab.

Customer satisfaction is our top priority

At Physioactif, excellence guides everything we do, but our patients are the best ones to tell you about it. Take a look at their verified reviews to get a real sense of their experience.

4.7/5