Ankle sprain

An ankle sprain is an injury that can cause the soft tissues that surround the ankle joint to overstretch.

Ligaments are tough bands of tissue which connect the bones of the leg to the foot, holding together the ankle joint and providing support. They have boundaries which they can stretch to, and when stretched beyond this, it can result in a tear.

The most common injury occurs to the ligaments on the outside of the ankle, known as the lateral ligament complex. You can also injure the ligaments on the inside of your ankle (medial ligament complex), and very occasionally, above your ankle joint in between your tibia and fibula (syndesmosis).

The ligament affected usually depends on which direction your foot is forced into during the initial injury.

How does a sprained ankle happen?

An ankle sprain often occurs when the foot suddenly twists, forcing the ankle joint out of its normal position. Most commonly you overstretch your lateral ligament complex, when your foot and ankle is forcibly turned inwards, this movement is called inversion.

Anyone at any age can have an ankle sprain. It can happen in various ways, such as playing sport, walking on uneven surfaces, or wearing inappropriate footwear. Unfortunately, when you sprain your ankle once, it can increase the chances of this happening again. This is why it’s important to improve the strength of the muscles around the ankle and work on balance exercises.

What are the symptoms of an ankle sprain?

A thorough examination by your GP or physiotherapist is usually enough to diagnose an ankle sprain. You may have heard an audible snap or crack as your foot turned inwards or outwards, and symptoms may include:

  • Swelling and bruising around the foot and ankle
  • Reduced range of movement
  • Difficulty walking
  • A feeling of instability

Physiotherapy and the recovery

Ankle sprains will usually settle down within six to 12 weeks. The length of time for recovery can vary depending on the severity of the injury.

More severe ankle sprains can affect other structures in your ankle, such as bones, muscles and cartilage. If an injury occurs to these structures too it can slow down the recovery and can cause quite persistent pain and swelling, although usually with time this will settle down.

If your ankle doesn’t settle down in the time you would expect, or you are having problems getting back to activities at work or sport, then contact your physiotherapist.

Rehabilitation stages

The initial focus of physiotherapy is to control the pain, reduce the swelling, and to start early movement of the ankle joint to prevent stiffness and muscle weakness. The Acronym MICE can help you with this:

Movement - when you feel able, you can start gradually building up walking distance and starting moving the ankle by doing the exercises.

Ice can be effective for pain relief and can be applied for a couple of days after the injury. Wrap the ice in a damp tea towel and apply every 1-2 hours for 10-20 minutes. If the area becomes itchy or the pain increases remove it.

Compression may be effective for pain relief and swelling. Tubigrip or a neoprene brace can be used and should feel tight, but not so much that you feel numbness or an increase in pain.

Elevation - supporting your ankle on pillows above the heart level may help with the pain and swelling.

If you went to an emergency department and sustained a severe ankle sprain, you may have been provided with a boot to provide some protection and support to the ankle. You can start weaning yourself out of the boot after 1-2 weeks or as symptoms allow. Also, it is important to remember to correctly take the right painkillers at the right time.

Movement and early ankle strengthening exercises

Below is a video demonstrating a range of movement exercises you can start as soon you feel able.

You may experience some discomfort whilst performing some of the exercises and this may persist for some time after finishing them. How much and how long the pain lasts for is something you will discuss with your physiotherapist, but usually if the pain and the length of the time the pain lasts for is acceptable to you, then it’s fine.

The pain you may experience after the exercises does not mean you are damaging anything. You can progress yourself gradually through the exercises as your pain, technique and swelling allows. This means if you have good technique, and you don’t experience any severe reactions like unacceptable pain and swelling after the exercises, then you can progress yourself onto the next video.


Early stage ankle exercises

Intermediate strengthening and balance exercises

Below are some intermediate strengthening exercises for the legs.

Although pain and swelling will eventually settle down, your injured ankle may not be as stable as your unaffected ankle. You may also notice that the whole leg feels weaker, so below are some exercises which will help strengthen the ankle, knee and hip.

Research shows that by strengthening the muscles in the leg, it can reduce any further injuries in the future.


Intermediate ankle exercises

Return to impact and running

Below are some later stage impact exercise videos designed to help with the later stages of rehabilitation. 

When getting back to sport, it is important to get the ankle used to the demands of your chosen activity prior to returning. The aim of these exercises is to continue building your confidence by testing your balance through jumping and hopping drills. If you are unsure if you are ready to start these exercises or return to sport, you can discuss this with your physiotherapist.

Progressive impact exercises

Early agility and plyometrics