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 that surround 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.

In the ankle, the most commonly sprained ligament 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 types of ankle sprains depending on which ligament is involved.

1. 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 so 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 to the structures that attach 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 which 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 Medial Ankle Sprains are typically accompanied with ankle bone fractures. 

After an ankle sprain, you likely have inflammation which will result in pain around the area of the ankle sprained, 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

Grade 1

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

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

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.

After an ankle sprain, there is significant, and many people think they broke 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.

1. You have a tenderness to the bone of any of the 4 spots in the picture.

2. 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. 

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 if needed 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 https://www.dsmcapitalortho.com/walk-in-clinic.

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.

Instead of RICE, immediately after the injury we now recommend PEACE & LOVE.

For the first few days after an ankle sprain, you need 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 (for optimal healing)- 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 (https://amzn.to/4aDYZqc) , Compression Sock (15-20mmHg tightness) https://amzn.to/40HVbzA orPneumaticc Compression Boots https://amzn.to/416FfZv 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 few 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.

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 back 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

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. 

1. Physically- can do you 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.

2. 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.

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.

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.

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. 

An ankle sprain is the most common musculoskeletal injury suffered by athletes and average adults. The majority of mild and moderate ankle sprains can be managed on your own and with some rest and normal daily activity will not have lasting effects. 

However, if you have a moderate to severe ankle sprain, you’d greatly benefit from working with a physical therapist. The role of a physical therapist is to help maximize what you are doing during the healing process. A physical therapist specializes in creating a structured rehab plan to keep you in the Goldilocks Zone and back to normal faster and prevent future ankle sprains.

An ankle sprain is the most common musculoskeletal injury suffered by athletes and average adults. The majority of mild and moderate ankle sprains can be managed on your own and with some rest and normal daily activity will not have lasting effects. 

However, if you have a moderate to severe ankle sprain, you’d greatly benefit from working with a physical therapist. The role of a physical therapist is to help maximize what you are doing during the healing process. A physical therapist specializes in creating a structured rehab plan to keep you in the Goldilocks Zone and back to normal faster and prevent future ankle sprains.

The best way to heal an ankle sprain is not just resting but 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.