An ankle sprain is one of the most common sporting injuries, but you don’t need to be an athlete to have a sprained ankle. They can happen to anyone.

What is an ankle sprain?

There are different types of ankle sprains, the most common – a lateral ankle sprain – accounts for 90% of ankle sprains.  A lateral ankle sprain is injury to the ligaments on the outside of your ankle. This happens when your ankle is rolled inwards under force, stretching the ligaments further than they are made to stretch. The overstretching causes ligament tearing, and the degree of ligament tearing can be graded from grade 1 (mild) to grade 3 (severe).

The Ankle Joint

To properly diagnose or grade a sprained ankle a comprehensive clinical assessment is needed. Manual testing (treating clinician physically tests ligament integrity) is best done 5 – 7 days after your injury.  Ultrasound can be done much sooner and gives your treating clinician a picture of the level of damage your ligaments have suffered and pick up any subtle bone injuries that are often not visible on x-ray. X-ray is generally only needed when your treating clinician finds that you meet the Ottawa Ankle Rules

Sprained Ankle Treatment

Immediately after injury, you should follow the P.O.L.I.C.E principles:

  • Protection
    • It is often necessary to have a short period (1 – 2 weeks) of immobilisation, for example in a camboot.
    • A boot can help you walk sooner and allows the ligaments to begin to heal in a good position.
  • Optimal Loading
    • Research has shown that early loading in sprained ankles benefits your strength, function and quality of ligament healing.
    • Your treating clinician can guide you on what “Optimal Loading” looks like for you.
  • Ice 
    • 15 – 20 min every other hour, remembering to protect your skin from ice burns.
    • Ice can help with pain and swelling.
  • Compression
    • A simple sock compression bandage works well.
    • Aim to prevent fluid pooling in your ankle, swelling restricts your ankle movement and slows down recovery.
  • Elevation
    • Integral to keep swelling down
    • Aim to have your ankle higher than your heart, or at least above the level of your groin.

Heat or heat rubs, alcohol, running/moderate activity and massage at this point will only increase bleeding and swelling, so avoid these.

Having a treating clinician to guide you is essential for optimal recovery. They will know when it is safe for you to wean out of the camboot, fit your ankle brace (if needed), ensure you are wearing supportive footwear, and progress your rehabilitation program.

Rehabilitation needs to include:

  • Restoring full range of movement to the ankle.
  • Restoring full strength to the leg/foot.
  • Restoring balance on the injured side
  • Putting all of that together into functional exercises (i.e. hopping/twisting/changing direction).

Return to Sport (and life) after Ankle Sprain:

Ankle sprains are often quite debilitating and can unfortunately easily recur. With good rehabilitation, and a guided return to sport you can expect to back to your normal activities.

The exact time frame for returning to sport depends on a variety of factors including (but not limited to) the severity of your sprained ankle:

  • Mild – Grade 1 sprain: 1 – 3 weeks
  • Moderate – Grade 2 sprain: 2 – 6 weeks
  • Severe – Grade 3 sprain:  6 – 12 weeks

Having a treating clinician who specialises in feet and ankles will really help to reduce your risk of re-injury.