- Ankle sprain
- Injuries
- Physical therapy
Ankle sprain: what to do in the first days and how to keep it from happening again
An ankle sprain is the most common foot and ankle injury, and it can leave lasting instability if it isn't rehabilitated well. We explain what to do, when it's urgent, and what the clinical guideline recommends.
PainManagement ER Published 3 min read
A misstep off a curb or a bad landing from a jump, and your ankle rolls inward. According to the 2021 clinical practice guideline in the Journal of Orthopaedic & Sports Physical Therapy, an ankle sprain is the most common foot and ankle injury people seek medical care for. And it’s estimated that only about half of people who sprain an ankle see a professional.[2]
How to recognize it
According to the NHS, it’s likely a sprain if you have:[1]
- Pain, tenderness or weakness around the ankle
- Swelling or bruising
- Trouble putting weight on or using the foot normally
The first 2 to 3 days
The NHS recommends following the 5 steps of PRICE therapy:[1]
| Step | What to do |
|---|---|
| Protect | Protect the injury, for example with a support |
| Rest | Rest and avoid putting weight on it |
| Ice | Apply ice for up to 20 minutes every 2 to 3 hours |
| Compress | Compress it with a bandage during the day |
| Elevate | Raise the ankle on a pillow as much as you can |
Source: NHS, "Sprains and strains" (2024).[1]
During those first days, the NHS advises avoiding heat (hot baths, heat packs), alcohol and massage. Once you can move without pain stopping you, keep moving the ankle so it doesn’t get stiff.[1]
How long does it take to heal?
After 2 weeks, most sprains feel better. The NHS recommends avoiding strenuous exercise such as running for up to 8 weeks, and warns that severe cases can take months to get back to normal.[1]
The risk of it happening again
A poorly rehabilitated sprain can leave chronic ankle instability. The clinical guideline cites a study that followed patients for a year:[2]
One-year outcome after a first lateral ankle sprain (one longitudinal study)
- Returned to normal activity
- Developed chronic instability
What the clinical guideline recommends
| Recommendation | Grade |
|---|---|
| Use external supports (brace or taping) and progressively put weight back on the ankle | A |
| Rehabilitation with structured therapeutic exercise: range of motion, stretching, neuromuscular and balance training, in clinic and at home | A |
| Manual therapy alongside exercise, to reduce swelling and improve mobility | A |
| After a first sprain, a preventive brace and balance and proprioception training to lower the risk of another | A |
| Repeated ice as part of an exercise program | C |
| Don't use therapeutic ultrasound for an acute sprain | A |
Source: Martin RL, et al. JOSPT 2021.[2] Grade A = strong evidence; C = weak. The guideline focuses on physical therapy treatments.
When it’s urgent
The NHS advises getting urgent care if the pain is severe or getting worse, swelling or bruising is large or growing, you can’t put weight on it or walk more than a few steps, or you have a fever or chills.[1]
And go to the ER or call 911 if:[1]
- You heard a crack when you got hurt
- The ankle looks misshapen or at an odd angle
- It is numb or tingling
- The skin looks blue or gray, or feels cold
If you rolled your ankle and it isn’t improving, or it has happened more than once, an assessment and a rehabilitation plan can help keep it from happening again.
Sources
- Sprains and strains . NHS (UK National Health Service) , reviewed April 23, 2024.
- Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021 (clinical practice guideline) . Martin RL, et al. Journal of Orthopaedic & Sports Physical Therapy 2021;51(4):CPG1–CPG80 , April 2021.
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