Ankle Sprains : The Ultimate Guide

Ankle sprains are among the most common injuries, affecting athletes, fitness enthusiasts, and even those going about their daily routine. Whether it's caused by a sudden twist, an awkward landing, or a misstep on uneven ground, a sprained ankle can significantly impact mobility and day-to-day activities. While most minor ankle injuries heal with proper care, knowing how to manage the recovery process is crucial for avoiding long-term issues and preventing re-injury. This article provides a comprehensive guide on how to effectively recover from an ankle sprain, from immediate care to full rehabilitation, ensuring a safe return to normal activity.

Initial Care: First 48-72 Hours

The first phase is crucial to reduce swelling and pain, which can speed up the healing process. Failure to treat the injury correctly at this stage can risk worsening your condition or increasing your pain. The best way to minimise your pain early on is adhere to the RICE protocol to help with rest and relief as well as making use of pain medication where necessary. Non-steroidal anti-inflammatory drugs, otherwise known as NSAIDs, like ibuprofen and aspirin are effective at helping to reduce any pain, though it’s always worth taking with precaution when using any NSAIDs and managing your symptoms effectively. 

• Rest: Avoid putting weight on the injured ankle for the first few days. Typically, 24-48 hours is enough but allow 72 hours if needed. If there’s no sign of improvement by then, it is likely severe enough to require external support from a GP or specialist. Use crutches if needed to keep as much weight off your ankle as possible.
• Ice: Apply ice packs or cold compresses for 15-20 minutes every 2-3 hours. If you don’t have an ice pack, the old stand-by of a bag of frozen peas will do in a pinch. This reduces swelling and numbs the pain. Try and stick to 20 minutes and no more as this can do more harm than good overall. 
• Compression: Ensure that your ankle is properly wrapped and compressed. Elastic bandages are available at most supermarkets and pharmacists. This helps prevent further swelling but should not be too tight, as it can cut off circulation. Some signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling. Typically, you won’t need longer than 48-72 hours in the bandage. If swelling isn’t reducing, you should consider contacting an ankle doctor or 111 to get it checked.
• Elevation: If possible, keep the ankle elevated above the level of your heart, especially while resting. This doesn’t mean up in the air; if you are lying down, you can elevate your ankle simply on a few pillows. This encourages fluid drainage and reduces swelling. If you are struggling to move your ankle at all without severe pain, it might be worth checking with your doctor or 111 as this suggests a more severe injury.

Early Rehabilitation Phase: 3 Days to 2 Weeks

After the initial phase, it’s important to gently start mobilising the ankle, but without pushing it too hard or resulting in additional pain. You may encounter some pain as you work on putting more strain on your ankle so take your time and don’t just grit and bear it. This will, more often than not, cause more pain and risk worsening the injury. You want to be prioritising movement and strength in the first few weeks to help your ankle recover as fast as possible. While you are still recuperating, you should still avoid any high-impact activities or anything that would be particularly intense.

Reintroduce Movement:

• Start with gentle range-of-motion exercises. A common one is drawing the alphabet with your big toe while seated or lying down.
• Perform ankle pumps by moving your foot up and down, and side to side, to regain flexibility.
• Calf stretches can help maintain flexibility. Hold each stretch for about 30 seconds and repeat a few times a day.

Strengthening Exercises (as pain decreases):

• Towel scrunches: Use your toes to scrunch a towel placed on the floor.
• Resistance band exercises: Place a resistance band around your foot and gently pull it in different directions (up, down, and side to side) to build ankle strength.

Rehabilitation Phase: 2 to 6 Weeks

As the ankle improves, focus on rebuilding strength, stability, and balance. This phase is key to avoiding long-term weakness and re-injury. If you rush before your ankle is sufficiently strengthened, you risk damaging your ankle more or setting back your recovery time by weakening your ankle again.

Balance Exercises:

• Single-leg standing: Try standing on the injured ankle for 30 seconds at a time. Once comfortable, increase the difficulty by closing your eyes or standing on a soft surface.
• Proprioception training: This helps your body relearn how to stabilise the ankle. Use a wobble board or cushion for controlled instability exercises.

Strengthening Exercises:

• Heel raises: Stand with your feet shoulder-width apart and rise onto your toes. Perform this slowly and hold the position before lowering down.
• Lateral band walks: Place a resistance band around your legs and walk sideways to strengthen the muscles supporting the ankle.

Return to Activity: 6 Weeks and Beyond

By this stage, you should have regained most of your ankle’s mobility and strength and you should be able to do most activities without pain. However, it’s important to ease back into more strenuous activities or high-impact exercises. Exercises like cycling or swimming can be a really good space to enjoy more activity while keeping the pressure on your ankle minimal.

Gradual Return to Sport or Exercise:

• Start with low-impact exercises like cycling or swimming.
• Incorporate gentle running on even surfaces once you feel stable.
• Avoid jumping or twisting movements until your ankle feels strong enough.

Prevention Techniques:

• Ankle supports: Consider wearing a brace or tape your ankle during activities to provide extra stability.
• Continue strengthening exercises: Make ankle exercises a regular part of your fitness routine to maintain stability and avoid future sprains.

Signs to Watch for During Recovery

While most ankle sprains heal within 4-6 weeks, some may take longer. It’s important to monitor for any of these red flags for issues with your general recovery. If you experience any of these symptoms, consult an ankle doctor, as further investigation or physical therapy may be required.

• Persistent pain or swelling after several weeks
• Difficulty bearing weight on the ankle
• Instability or frequent re-injury
• A “popping” sound during movement

If you have been struggling with an ankle strain and are concerned that it could be something more severe, please get in touch. We have appointments available both privately and on the NHS so if you are experiencing ankle pain of any kind, please contact our team. We’ll be happy to support you throughout Leeds and West Yorkshire.