What Is the Best Treatment for an Ankle Sprain?
What Is the Best Treatment for an Ankle Sprain? (Expert Advice for a Fast Recovery)
Ankle sprains are one of the most common injuries, whether you’re an athlete, a weekend warrior, or just took an unexpected misstep. The pain, swelling, and stiffness can make it difficult to walk, exercise, or return to daily activities. But what’s the best way to heal an ankle sprain? Should you just rest, or is there something more effective?
In this article, you can expect to learn:
What happens when you sprain your ankle
The most common types of Ankle Sprains
When you should get an X-ray
The latest research-backed recovery method (PEACE & LOVE)
The 3 Phases of Rehab
Common mistakes that slow down healing
What Is an Ankle Sprain?
In the United States, approximately 2 million ankle sprains occur annually. A sprain is an injury that occurs when ligaments get stretched or torn and the ankle has many different ligaments that can be injured. Ligaments are the dense fibrous tissue that connects bones to other bones and the ankle has ligaments surrounding the ankle joint. Data shows that over 50% of people who go to the emergency room with an ankle sprain are not associated with organized sports or high levels of activity and occur in the general population with normal daily tasks such as stepping off a step or curb. An ankle sprain recovery varies greatly depending on the type and severity of the sprain.
What Happens When You Sprain Your Ankle?
The most commonly sprained ligament in the ankle is the ATF (Anterior Talofibular Ligament), which occurs during a lateral ankle sprain. Rolling your ankle is the most common mechanism which overstretches the ligaments on the outside of the ankle.
Right after you sprain your ankle you’ll likely start to have swelling, and pain around the ankle, and it may even be difficult to walk. As it progresses, you may experience bruising, lingering swelling, joint stiffness, redness, and warmth around the ankle. You can have different forms of ankle sprains depending on which ligaments are involved.
What are the different types of Ankle Sprains?
Lateral (Outside) Ankle Sprain
Nearly 80% of all ankle sprains are lateral ankle sprains which affect the 3 ligaments on the outside of the ankle. The reason this is a common occurrence is due to the bony anatomy of the ankle. The circle bone on the outside of your ankle sits lower than the side ankle bone causing it to roll to the outside. When the ankle rolls, the toes are pointed in and ankle bones roll out to the side which overstretches and damages the three ligaments on the outside of the ankle. This typically happens on an uneven surface, stepping off a step or curb, or in sports when coming down and landing on another athlete’s foot. Compared to other sprains, the ligaments on the outside of the ankle have good blood supply which allows nearly all sprains to heal without surgery.
2. High Ankle Sprain
The remaining sprains are less frequent and typically take more force to be injured. High ankle sprains occur in the structures that attach to the shin bones. This type of sprain happens when the foot is pointed and the toes go outside. The most common mechanics are in sports when another player falls on your leg from behind or when your toe gets caught and twists your ankle. Unlike the Lateral Ankle, the structures involved in high ankle sprains have a worse supply, and depending on severity, can lead to longer healing times or surgery to stabilize the ankle.
3. Medial (Inside) Ankle Sprain
Ankle sprains to the inside of the ankle account for around 3-4% of all ankle sprains. The inside ankle ligament is very strong and stable so isolated sprains of the inside of the ankle are rare.
Ankle sprains on the inside of the ankle medial ankle are typically accompanied by an accident or trauma and involve ankle bone fractures.
Common Symptoms of an Ankle Sprain
After an ankle sprain, you likely have inflammation, that will result in pain around the area of the ankle sprain, swelling, redness, bruising, and it may feel warm. Depending on how bad of a sprain, you may have difficulty putting weight on the foot to walk and require a boot or crutches. With swelling you’ll likely notice stiffness and occasional joint stiffness to protect the healing ligaments.
Usually, those who have sprained their ankle are still able to bear some weight compared to patients who have suffered an ankle fracture, which makes weight-bearing extremely difficult or impossible.
How to tell the Ankle Sprain Severity
Ligament sprain severity is determined by how far the ligament is stretched during the injury. Ankle sprains are graded based on how far the ligament is stretched during the sprain.
Grade 1- Mild
Slight stretching and microscopic tearing of the ligament fibers, commonly the anterior talofibular ligament. You will have mild tenderness and swelling around the ankle, typically recovers in 5-14 days. With a Grade 1 sprain, you’ll be able to put weight on it and get back to normal activities pretty quickly.
Grade 2- Moderate
With a Grade 2 tear, you’ll have partial stretching of the ligament with partial tearing of the anterior talofibular ligament and some tearing of the calcaneofibular ligament. You’ll have moderate tenderness and swelling around the ankle, which typically takes 2-6 weeks to recover. Depending on the location, you’ll have significant bruising and swelling may have difficulty putting weight on your leg after the sprain, and may require a walking boot or crutches.
Grade 3- Severe
With this type of sprain, you’ll have a complete tear of the anterior talofibular ligament, the calcaneofibular, and the posterior talofibular ligament. Significant tenderness and swelling around the ankle and foot can take 6-12 weeks to fully recover. Nearly 85% of Grade 3 Ankle Sprains will get better conservatively but a small number do require surgery to back to the prior level.
Do I need an X-RAY for an Ankle Sprain?
After an ankle sprain, there is significant pain, and many people think they have broken their ankle and need to get an x-ray. Grade 2 and 3 ankle sprains can look more severe than they are with the swelling and bruising. Use these rules to determine if you need to head to urgent care and get an x-ray.
You need an X-RAY after an Ankle Sprain if…
You have a tenderness to the bone of any of the 4 spots in the picture.
You aren’t able to put weight on your leg to walk.
If you aren’t able to put weight on your leg, you may need a walking boot or crutches to help get around for a few days or weeks so you will likely need to head to the doctors office.
Pro Tip: Orthopedic Surgeon offices typically have a Walk-In Care clinic and are the best place to go because they will have an x-ray machine and equipment such as a boot or crutches if necessary.
In the Des Moines area, I frequently recommend Capital Orthopaedics and Sports Medicine in Clive and Ankeny ,
How to Treat an Ankle Sprain at Home (Best Immediate Care Tips)
So if you made it this far in the article, you probably sprained your ankle and are wondering what to do. Regardless of the Grade of the Ankle Sprain, you’ll follow the same process. Just understand, the more severe the sprain, the longer it’s going to take to get through the process.
You probably remember medical professionals recommending RICE (Rest Ice Compression Elevation) for ankle sprain recovery. After years of recommending RICE, we found that most people focused on resting and avoiding all activities which resting too much leads to delayed recovery. The most cutting edge research shows that the fastest injury rehabilitation happens with PEACE & LOVE.
PEACE&LOVE: The New Approach to Injury Rehab
Instead of RICE, immediately after the injury we now recommend PEACE & LOVE.
For the first 1-5 days after an ankle sprain, you need to focus your rehab on PEACE
Protection- walking pain-free is important, protect the injury for the first few days with a brace, crutches, or boot as needed but the goal is to use as little support as necessary and walk pain-free as fast as you can.
Elevation- the inflammation process and gravity bring swelling to the ankle, elevating the leg can help the swelling move up toward the heart
Avoid Anti-Inflammatory Medications - inflammation brings healing factors to the sprained ligament so you don’t need to take Ibuprofen or Aleve immediately. If you need something for pain, start with Tylenol or if the pain is manageable, skip the anti-inflammatories like ibuprofen and Aleve.
Use Ice for pain relief as needed. Ice doesn’t improve the inflammation process and may even slow the healing process initially.
Compression- elevation, and compression are the best ways to help you get swelling out of the ankle. An ACE Bandage Wrap , Compression Sock (15-20mmHg tightness) or Pneumaticc Compression Boots are all great options
Education- You need to understand the Goldilocks Zone of how much rest and activity you need depending on the type and severity of the ankle sprain. Skip Google and ChatGPT, which will likely tell you you have an infection or ankle cancer. A good Physical Therapist will happily tell you what to expect, what to do, and what not to do, and help you accelerate the healing process.
After the first 1-5 days subside, it’s time to give that ankle sprain some LOVE.
Load- Ankle sprains get better faster with an active approach including movement and exercise. Get back to normal activities and walking as tolerable. Adding in movement promotes repair and remodeling and builds tissue tolerance and capacity to get back to normal.
Optimism- If you’ve ever had an injury, you know how mentally taxing it can be. You will get better, you will get back to doing everything you were doing before your ankle sprain, and it’s very rare to need surgery after an ankle sprain.
Vascularization- Blood flow is VITAL to the healing process and is the missing piece of RICE. Get back to movement and exercise as fast as you can. Riding a bike or doing upper body strength exercises will help you heal FASTER.
Exercise- You need to restore your MOBILITY, STRENGTH, and BALANCE of the ankle. It will take time and the right exercises but don’t neglect this step. If you don’t fully rehab your ankle, you can have limited mobility and even reoccurring ankle sprains.
Best Exercises for an Ankle Sprain (Rehab Plan for Fast Healing)
Phase 1: Restoring Range of Motion
Swelling brings a limited Range of Motion of your foot and ankle so the faster you get that back, the faster you will be walking again.
You should AVOID STRETCHING the foot and ankle during Phase 1!!! The ankle ligaments are already overstretched so stretching them delays the healing process.
To get your Range of Motion back, start with Ankle Pumps and Ankle ABC
VIDEO- Ankle Pumps
VIDEO - Ankle ABC
Phase 2: Strengthening the Ankle Muscles
Once the range of motion starts to come back, it’s time to strengthen the ankle muscles. Strengthening the muscles around the ankle helps the overstretched tissue heal and return to its normal length. This is THE most overlooked phase of ankle sprain recovery and is critical to returning the ankle ligaments to the pre-injury state.
When choosing the strengthening exercise, we must consider the Goldilocks Principle. You want to pick an exercise that is hard enough to make a change, but not too challenging that it overstresses the healing ligament and slows the healing process. Here is a simple progression of the commonly prescribed ankle-strengthening exercises.
Band Ankle Eversion
Band Ankle Inversion
Calf Raise- 2 Leg
Calf Raise- 1 Leg
Squats, Deadlifts, Lunges, Walking
Phase 3: Balance and Proprioception
If your goal is to get back to running or sporting events, your ankle needs to get back to a higher level of balance, stability, and plyometrics (jumping). You could argue that every person should do some form of plyometric training to build up strength in their bones and prevent bone loss with aging, but that’s a topic for another day.
Continue to use the Goldilocks Zone of challenging the ankle to build up resilience to tolerate the demands of running and sports and also build your confidence to trust your ankle not to give out.
Single Leg Balance- unstable surface
SL RDL
Jumping- 2 legs in place or Jump Rope
Jump - 2 leg line jump
Jumping- 1 leg in place
Jumping- 1 leg line jump
When can you return to running or sports?
Getting back to sports is variable based on the type and severity of the ankle sprain. Getting back to running and sports after an ankle sprain has many variables. You need to consider how you feel physically and mentally going back to running or sports.
Physically- do what you need to do without feeling your ankle is going to give out. If you can do line jumps side to side for 60 seconds, you are likely physically ready to participate in sports or running.
Mentally- do YOU feel ready or is there hesitation or fear of reinjury? It’s never a good idea to go back to sports when you mentally don’t trust your leg.
If you are looking to get back to sports or running after an ankle sprain, you should consult with a physical therapist to help make the decision based on the type of sprain, severity, and time after injury.
Common Mistakes That Can Delay Healing
Ignoring the injury and returning to activity too soon.
Respect the injury. Not every ankle sprain is the same and can vary drastically. Sometimes a mild sprain or tweak can get better within a couple of days but if you have a more severe injury, don’t rush back and return to full activities too soon.
2. Over-relying on braces or tape instead of rebuilding strength
Ankle braces are fine and should be used right after a Moderate to Severe ankle sprain, but you don’t want to rely on the brace for stability long term. Strengthening the ankle is KEY to getting the ankle stable enough to prevent another injury.
3. Not following a structured rehab plan.
Time and Consistent Targeted Strength and Mobility work will heal nearly all musculoskeletal injuries. When it comes to ankle sprains, you want to be in the Goldilocks Zone. Doing nothing and understressing the injury will delay the healing time and doing too much too fast will aggravate the injury and slow you down.
A structured plan that keeps you in the Goldilocks Zone is KEY to getting your ankle back to how it was feeling before the sprain.
Should you see a Physical Therapist for an Ankle Sprain?
An ankle sprain is a common musculoskeletal injury endured by athletes and average adults. The majority of ankle sprains are mild to moderate and can be managed on your own and with some rest and normal daily activity. But what happens more often, is you rest, not fully rehab your ankle, and end up with a “bad ankle.”
If you want to make sure your ankle sprain doesn’t have long lasting effects, it’s best to get a consultation with a physical therapist to put together a custom program to get you back to feeling like you did before your sprain.
The Bottom Line: The Best Treatment for an Ankle Sprain?
The best way to heal an ankle sprain is not only resting but also following a structured rehab plan.
Implement PEACE & LOVE, progressive strengthening, and balance/plyometric training for the best recovery.
If you have questions about your injury or need a structured plan for your problem, book a Free Strategy Call using the button below.
Dr. Ryan
