Ankle Sprain Causes and Treatment

Treatment and Rehab Can Reduce Ankle Sprain Recovery Time

Testing mobility of foot.
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What Is an Ankle Sprain?

The most common of all ankle injuries, an ankle sprain, occurs when the ligaments surrounding the ankle joint are stretched beyond their ability to withstand the force and end up tearing. The tear can be minor or major and the recovery time depends on the degree of the sprain.

What Causes Ankle Sprains?

The most common cause of an ankle sprain is applying weight to the foot when it is either inverted or everted position.

Commonly, this happens while running or jumping on an uneven surface. The foot rolls in (inversion) or out (eversion) and the ligaments are stretched.

Occasionally a loud "snap" or "pop" is heard at the time of the sprain. This is usually followed by pain and swelling of the ankle. This type of sprain, while sometimes due to a lack of lower limb strength, endurance or flexibility, is also often the result of a lack of balance or proprioception, to be exact.

Ankle Sprain Severity

Ankle sprains are classified by the degree of severity. 

  • Grade I - stretch and/or minor tear of the ligament without laxity (loosening).
  • Grade II - a tear of ligament plus some laxity.
  • Grade III - complete tear of the affected ligament (very loose).

Test Your Risk for an Ankle Sprain

If you play field or court sports, you might be interested in a simple test to predict your risk for an ankle sprain. Researchers found that a simple, inexpensive screening tool can predict which athletes may be more likely to have an ankle injury and developed a simple training routine to help reduce that risk.

Treating Ankle Sprains

For immediate relief, you can use the R.I.C.E. treatment plan.Rest, ice, compression and elevation. While there is general agreement that the best approach to an ankle sprain is immediate rest, there is some conflicting advice about what comes next. Many experts still believe ice, compression and elevation help healing, but some are questioning this approach.

Until definitive answers are available, the following approach is still the most widely recommended.

  • Rest. Avoid weight bearing for 24 hours or longer for a severe sprain.
  • Ice. Apply ice (bagged, crushed ice wrapped in a thin towel) to the ankle joint. To avoid frostbite, ice should not be left on the area longer than 20 minutes at a time. Ice 20 minutes every 2 hours for the first 24 hours to control swelling.
  • Compression. Wrap the ankle with an elastic bandage (start at the toes and wrap up to the calf) to help prevent swelling and edema.
  • Elevation. Raise the ankle above the hip or heart to reduce swelling.
  • If the swelling doesn't subside in 48 to 72 hours, seek medical treatment for a complete evaluation.
  • If unable to weight bear within 48 hours, seek medical treatment

Ankle Sprain Rehab Exercises

After the initial 24 - 48 hours of rest and icing, you slowly begin weight bearing over several days as tolerated. Continue using crutches to avoid full weight bearing during this phase. Gradually progress to full weight bearing as tolerated. Try to use a normal heel-toe gait when you do start weight bearing. Continue using an ankle brace to protect the joint from re-injury.

Rehabilitation exercises should be begun as soon as tolerated, without pain.

Range of motion (ROM) exercises should be begun early in the course of treatment. One simple ROM exercise is to draw the letters of the alphabet with your toes. Gradual progression to other weight-bearing exercises should follow shortly after.

Any ankle injury that does not respond to treatment in 1-2 weeks may be more serious. Always consult a physician for a thorough evaluation and diagnosis.

Preventing Ankle Sprains

It may be difficult to avoid that missed step, uneven ground, or trip off the curb, but according to several study results, if you've practiced one simple exercise, you may walk away without a serious injury.

Five minutes of balance training with a balance board, a foam pad, and even one-leg standing, have been shown to significantly reduce the risk of ankle sprains in athletes. The exercises don't need to be complicated or involved, just consistent. And after you've sprained your ankle, you're at higher risk for another ankle injury, so it's even more important to perform balance training exercises as a part of rehab and to keep doing them as part of your regular workouts.

A study published in The American Journal of Sports Medicine concluded that a proprioceptive balance board program is effective for prevention of ankle sprain recurrences. Another study found that balance training reduced the risk of noncontact inversion ankle sprains in high school football players.

Read more about a balance training and ankle sprain rehab:


Evert Verhagen, Allard van der Beek, Jos Twisk, Lex Bouter, Roald Bahr, and Willem van Mechelen. "The Effect of a Proprioceptive Balance Board Training Program for the Prevention of Ankle Sprains." Am J Sports Med September 2004 vol. 32 no. 6 1385-1393.

Malachy P. McHugh, Ph.D., Timothy F. Tyler, MSPT, Michael R. Mirabella, ATC, Michael J. Mullaney, DPT, and Stephen J. Nicholas, MD. "The Effectiveness of a Balance Training Intervention in Reducing the Incidence of Noncontact Ankle Sprains in High School Football Players," Am J Sports Med August 2007 vol. 35 no. 8 1289-1294

Sprained Ankle, OrthoInfo, American Academy of Orthopaedic Surgeons, February, 2016.

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