An ankle sprain happens when one or more of the ligaments supporting the ankle are stretched or torn. Most ankle sprains affect the ligaments on the outside of the ankle, often after the foot rolls inwards. Pain, swelling, bruising and difficulty walking are common, but the severity of the injury and the rehabilitation needed can vary considerably.
What Is An Ankle Sprain?
A “sprain” is an injury to a ligament.
Ligaments are strong bands of tissue that connect bones and help support a joint.
The most commonly injured ankle ligaments are on the outside of the ankle. One of these is the anterior talofibular ligament (ATFL).
This is commonly injured when the foot rolls inwards and the ankle twists.
How Does An Ankle Sprain Happen?
An ankle sprain can happen when the foot or ankle moves beyond the position the ligaments can comfortably control.
Common situations include:
- Rolling the ankle while walking or running.
- Landing awkwardly after jumping.
- Changing direction during sport.
- Stepping onto an uneven surface.
- Contact with another player.
- Losing balance while the foot is planted.
If you have previously sprained your ankle, you may be at greater risk of another ankle sprain.
This is one reason why rehabilitation should go beyond simply waiting for the pain and swelling to settle.
Restoring movement, strength, balance and the ability to tolerate the demands of your activity can all form part of rehabilitation.
Learn more about Ankle Sprain Physiotherapy by clicking here.
What Are The Different Types Of Ankle Sprain?
Ankle sprains are commonly described using three grades.
However, the grade alone does not tell us everything about how somebody will recover or exactly what treatment they will need.
Grade 1 Ankle Sprain
A mild injury to the ligament.
You may experience:
- Localised pain or tenderness.
- Mild swelling.
- Some discomfort when walking or exercising.
Grade 2 Ankle Sprain
A more significant ligament injury involving partial tearing.
You may experience:
- Moderate pain.
- Swelling.
- Bruising.
- Difficulty walking normally.
- Reduced movement.
- A feeling of instability.
Grade 3 Ankle Sprain
A severe ligament injury involving complete rupture.
This can cause:
- Significant swelling or bruising.
- Difficulty putting weight through the ankle.
- Reduced movement.
- Significant instability.
However, symptoms do not always correspond perfectly with the grade of injury.
A severe ankle injury can also involve a fracture or damage to other structures, so assessment can be important when symptoms are significant.
How Do I Know If My Ankle Is Sprained Or Broken?
It is not always possible to tell from symptoms alone.
Pain, swelling, bruising and difficulty walking can occur with both ankle sprains and fractures.
You should seek appropriate medical assessment if:
- The ankle or foot has changed shape.
- You heard a crack during the injury.
- You cannot walk or put weight through the foot.
- You have severe or worsening pain.
- You have numbness or altered sensation.
- The foot becomes unusually cold or changes colour.
- You are concerned that the injury may be more serious than a sprain.
A healthcare professional can assess whether an X-ray or further investigation is required.
What Should I Do After An Ankle Sprain?
What you should do depends on the severity of the injury.
During the early stages, reducing aggravating activity and protecting the ankle may help manage pain and swelling.
Ice can be used for short-term pain relief if you find it helpful. Avoid placing ice directly against the skin.
However, complete rest until all pain has disappeared is not usually the goal.
As symptoms allow, gradually restoring comfortable ankle movement and putting weight through the foot can form an important part of recovery.
Some people may temporarily need additional support such as crutches, a brace or a walking boot depending on the severity of the injury.
If you are unsure how much weight you should put through the ankle, or whether your injury needs further assessment, seek appropriate clinical advice.
How Is An Ankle Sprain Rehabilitated?
Once the early symptoms allow, rehabilitation can gradually work towards restoring what the ankle needs to do.
This may include:
- Restoring ankle movement.
- Gradually increasing weight-bearing.
- Building calf and ankle strength.
- Improving balance and control.
- Progressing walking and everyday activity.
- Reintroducing running and jumping where appropriate.
- Reintroducing changes of direction for sport.
- Building confidence in the ankle again.
The exact progression depends on the severity of the injury and what you need to return to.
Someone returning to normal walking may require a different rehabilitation programme from somebody returning to football, rugby, tennis or running.
Learn more about how exercise rehabilitation can help by clicking here.
Why Can Ankle Sprains Keep Happening?
A previous ankle sprain is an important risk factor for another ankle sprain.
That does not mean another injury is inevitable.
After an ankle sprain, movement, strength, balance and control may not immediately return to their previous level.
Some people also return to sport or exercise once the pain has improved without fully rebuilding the demands their ankle needs to tolerate.
This is why rehabilitation can continue beyond the point where the ankle simply “feels better”.
The goal is to progressively prepare the ankle for the activities you want to return to.
Do Grade 3 Ankle Sprains Always Need Surgery?
No.
A complete ligament tear does not automatically mean that surgery is required.
Management depends on the injury, whether other structures are involved, the stability and function of the ankle, your activity requirements and how the ankle progresses.
Some severe injuries may initially require greater protection or immobilisation followed by rehabilitation.
Surgery may be considered in selected cases, but it should not be presented as the routine treatment for every Grade 3 ankle sprain.
If you have sustained a significant ankle injury and cannot comfortably put weight through it, or you are concerned about a fracture or more serious injury, seek appropriate medical assessment.
Do I Need A Scan For An Ankle Sprain?
Not every ankle sprain requires a scan.
The first question after a significant ankle injury is often whether a fracture needs to be ruled out.
A healthcare professional can use your history and physical examination to help determine whether an X-ray is appropriate.
Further imaging may sometimes be considered if symptoms are not progressing as expected or if another injury is suspected.
An MRI is therefore not automatically required simply because you have sprained your ankle.
When Should I Get An Ankle Sprain Assessed?
Many mild ankle sprains improve with appropriate self-management and gradual return to activity.
Assessment may be useful if:
- You are struggling to walk normally.
- Pain or swelling is significant.
- Movement remains restricted.
- The ankle repeatedly gives way.
- You keep spraining the same ankle.
- You are struggling to return to running or sport.
- Your symptoms are not improving as expected.
- You are unsure how to progress your rehabilitation.
If there are signs that you may have sustained a fracture or another significant injury, more urgent medical assessment may be appropriate.
Can Physiotherapy Help After An Ankle Sprain?
Physiotherapy and rehabilitation can help assess how the ankle is recovering and progressively rebuild what you need for everyday activity, exercise or sport.
Depending on what we find during your assessment, rehabilitation may focus on movement, strength, balance, control and gradually increasing the demands placed on the ankle.
The aim is not simply to make the ankle less painful.
It is to help you progressively return to the activities that matter to you.
Learn more about Ligament Sprain Physiotherapy in London by clicking here.
Still Struggling With An Ankle Sprain?
If your ankle is not recovering as expected, keeps giving way or you are struggling to return to exercise or sport, we can assess the problem and help you understand what to do next.
At Fit2Function, your first appointment lasts 60 minutes and gives us time to understand the injury, assess your movement and strength, explain what we find and build a plan around what you want to return to.
Learn more about Ligament Sprain Physiotherapy in London by clicking here.
Learn more about our Physiotherapy services in London by clicking here.
Learn more about our Exercise Rehabilitation services in London by clicking here.
Book your Initial Assessment by clicking here.
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