How do I manage my ankle sprain?

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 them ⁴
• 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.

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.

Une douleur soudaine peut faire peur et empêcher de bouger. Prenez un moment pour respirer et observer votre pied. Allez à l’urgence si votre pied est déformé, froid, bleu ou engourdi après la blessure. Une douleur très forte ou qui augmente, une grosse enflure ou l’impossibilité de marcher quelques pas demande aussi une évaluation rapide, selon le NHS⁶.

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 program. Don’t force yourself just to take a few steps: your ability to walk is part of the evaluation, along with bone pain. ^{5, 4}

Une évaluation rapide est nécessaire si vous ne pouvez pas marcher quelques pas ou si un point osseux est très douloureux. Le professionnel détermine si une radiographie est indiquée, notamment avec les règles d’Ottawa pour la cheville et le pied⁷. La peur peut limiter l’appui, mais elle ne doit pas servir à expliquer une incapacité à marcher sans examen.

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 already suffered a sprain, the journal estimates the risk of recurrence to be 64% of that observed without this training, representing a relative reduction of 36%. This finding pertains to the exercise program, not a mandatory start date. ^{8, 4}

Pendant cette phase, surveillez la douleur, l’enflure et votre façon de marcher. Réduisez la durée ou la difficulté des exercices si les symptômes augmentent pendant l’activité ou après. Demandez conseil si cette réaction persiste.

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, some 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 outcome. ^{9, 4}

Un essai mené auprès de 522 sportifs a évalué huit semaines d’exercices d’équilibre ajoutés après les soins habituels. Une nouvelle entorse a été rapportée par 22 % du groupe avec exercices, contre 33 % du groupe témoin pendant l’année suivante. Ce programme soutient la poursuite d’exercices pour prévenir les récidives¹⁰.

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.

Sources

1. Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg. 2013;133(8):1129-41.↩ Back to text
2. Altomare D, Fusco G, Bertolino E, Ranieri R, Sconza C, Lipina M, et al. Evidence-based treatment choices for acute lateral ankle sprain: a comprehensive systematic review. Eur Rev Med Pharmacol Sci. 2022;26(6):1876-1884.↩ Back to text
3. Ortega-Avila AB, Cervera-Garvi P, Marchena-Rodriguez A, Chicharro-Luna E, Nester CJ, Starbuck C, et al. Conservative Treatment for Acute Ankle Sprain: A Systematic Review. Journal of Clinical Medicine. 2020;9(10):3128.↩ Back to text
4. Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.↩ Back to text: 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th mentions
5. Arnold MJ, Moody AL. Common Running Injuries: Evaluation and Management. Am Fam Physician. 2018;97(8):510-516.↩ Back to text: 1st, 2nd, 3rd mentions
6. NHS. Sprains and strains. National Health Service (Royaume-Uni).↩ Back to text
7. Ottawa ankle rules (adult). ECAT appendix, Emergency Care Institute, Agency for Clinical Innovation (NSW Health).↩ Back to text
8. Rivera MJ, Winkelmann ZK, Powden CJ, Games KE. Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review. J Athl Train. 2017;52(11):1065-1067.↩ Back to text
9. Michels F, Wastyn H, Pottel H, Stockmans F, Vereecke E, Matricali G. The presence of persistent symptoms 12 months following a first lateral ankle sprain: A systematic review and meta-analysis. Foot Ankle Surg. 2022;28(7):817-826.↩ Back to text
10. Hupperets MD, Verhagen EA, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009.;339:b2684.↩ Back to text

Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.