Have you ever rolled your ankle while walking on grass, stepping off a curb, or crossing an uneven parking lot? You’re not alone. According to Massachusetts General Hospital, over 1 million ankle injuries occur each year—and about 85% are sprains.
That makes ankle sprains the most common joint injury, and without proper care, they can lead to chronic ankle instability, long-term pain, and limited mobility.
What Is an Ankle Sprain?
An ankle sprain happens when one or more ligaments in your ankle are stretched or torn, usually due to a sudden twist or roll.
Ankle sprains typically occur when the foot rolls inward (inversion) or outward (eversion) too far, stretching or tearing the ligaments that support the joint. Ankle sprains are the most common joint injury and can lead to long-term ankle instability, pain, and reduced quality of life if not treated properly.
A Quick Look at Ankle Anatomy:
The ankle joint includes three bones:
- Tibia: the main shinbone
- Fibula: the smaller bone on the outside of your lower leg
- Talus: the bone at the top of your foot
These bones are connected by ligaments, which stabilize the joint. When too much force is applied—like when your foot rolls inward or outward too far—these ligaments can become damaged.
Types of Ankle Sprains
Sprains are typically categorized into three grades:
- Grade 1 (Mild): Slight stretching or microscopic tears in the ligament. Symptoms include mild swelling and soreness, with recovery in a few days.
- Grade 2 (Moderate): A partial tear of the ligament, often causing moderate swelling, bruising, and difficulty walking. Physical therapy is often recommended. Recovery takes 2–4 weeks.
- Grade 3 (Severe): A complete tear of the ligament. This often requires crutches, physical therapy, and sometimes surgery. Recovery may take 8–12 weeks.
What Causes an Ankle Sprain?
Most initial ankle sprains occur due to trauma. This may be a sports-related injury, a car accident, or a fall at home due to tripping on an object on the floor. The mild sprain can become chronic if untreated, and the ankle is injured again in less than 6 months. Due to the inelasticity of the ligament structure, the more the ankle is sprained, the more unstable it becomes. In other words, it does not take as much force to sprain the ankle again as it did the first time. Other common causes include walking or running on uneven surfaces, landing awkwardly from a jump, sudden twists during sports or daily activities, or wearing unsupportive footwear. Weak muscles, past ankle injuries, and poor balance can all increase the likelihood of a sprain.
What Are the Symptoms of a Sprained Ankle?
A sprained ankle can range from mildly irritating to severely debilitating, depending on the grade and severity of the ligament damage. Symptoms typically appear shortly after the injury and can vary in intensity. Some of the most common signs of an ankle injury include:
- Pain: This may occur along the outside or inside of the ankle, especially when bearing weight or trying to move the joint.
- Swelling: A swollen ankle is one of the most obvious symptoms and often appears within the first few hours of injury.
- Bruising: Discoloration around the ankle or foot can indicate torn ligaments and internal bleeding.
- Tenderness: The ankle may be sensitive to touch, particularly along the injured ligaments.
- Instability: A feeling that the ankle is “giving out” during activity is a hallmark of chronic ankle instability, especially after multiple sprains.
- Limited Range of Motion: You might notice stiffness or difficulty flexing or pointing the foot.
- Popping Sensation at the Time of Injury: Some people report hearing or feeling a pop during the sprain, which can be associated with ligament tearing.
If symptoms persist beyond a few days, or if you’re experiencing recurring ankle sprains, it’s important to seek a proper diagnosis. Ignoring the signs may lead to long-term instability and increased risk of re-injury.
Diagnosing and treating an ankle sprain
Thankfully a severe ankle sprain can be managed. However, the treatment is not as simple as Rest, Ice, Compression, and Elevation (R.I.C.E) followed by a few exercises at the ankle to make it go away. According to research done by Arnold, Wright, and Ross in 2011, patients with chronic ankle instability loss proprioception (body awareness in space), strength, and function. So, for ankle treatment to be effective, it must address all these issues.
When diagnosing an extremity injury, it is easy to isolate the injury site. For example, the physician may instruct, “The lateral ankle ligaments are a Grade 2 sprain. Put the patient on crutches, ice the injured ankle, prescribe NSAID and initiate ankle range of motion exercise in the next week.” This addresses the ankle injury. However, this approach misses an important part of the recovery and return to full function. As a matter of fact, if you follow this approach and return the patient to the prior level of function, they are just as likely to reinjure the same ankle in the near future.
How physical therapy can help an ankle sprain and prevent reinjury
Mild sprains often improve with the R.I.C.E. method (Rest, Ice, Compression, Elevation), but more severe sprains typically require a more structured treatment plan. Research shows that simply resting the ankle doesn’t address all of the critical factors needed for full recovery—especially in cases of chronic ankle instability, where patients may lose strength, proprioception (body awareness), and function.
A Better Recovery Plan Should Include:
- A full evaluation of ankle and lower body mechanics
- Guided strength-building and balance exercises
- Manual therapy and range-of-motion work
- Education on proper footwear and bracing if needed
How Physical Therapy Helps Prevent Future Sprains
At Ivy Rehab, our physical therapists take a whole-body approach to recovery. Treating just the ankle isn’t enough—especially if poor biomechanics elsewhere in the leg or hip are increasing your risk of reinjury.
For example, a weak gluteus medius muscle in the hip can cause poor control during walking or running, shifting your center of gravity and making it easier to roll your ankle on uneven surfaces.
By strengthening key muscle groups, improving balance, and retraining how you move, physical therapy helps you heal faster—and stay that way.
Stop Letting Ankle Pain Hold You Back
If you’re dealing with ankle pain, weakness, or repeated sprains, don’t wait. An untreated sprain can turn into chronic instability, but early treatment can get you back on your feet faster—stronger than ever. We can set you up with a free injury screening. From there we can determine the proper course of action and address the whole problem.
Reclaim Your Strength and Mobility
Experience personalized physical therapy that targets ankle pain, swelling, and instability at the root.
Written by Michael Bennington, PT, Clinic Director, Ivy Rehab Physical Therapy, Washington, Illinois
Article Reviewed by Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA
Holly Lookabaugh-Deur, PT, DSc, GCS, CEEAA is a practicing physical therapist and a partner and Director of Clinical Services at Ivy Rehab Network. Deur is board certified as a geriatric clinical specialist and certified exercise expert for aging adults with more than 35 years of clinical experience. She is certified as an aquatic and oncology rehabilitation specialist and serves as adjunct faculty at Central Michigan University and Grand Valley State University.
Resources:
- https://www.massgeneral.org/ortho-foot-ankle/conditions-treatments/ankle-instability.aspx
- Arnold, B.L., Wright, C.J., Ross, S.E. (2011). Functional ankle instability and health-related quality of life. Journal of Athletic Training, 46(6), 634-641.
- Docherty, C.L., Valovich, McLoed, T.C., & Shoultz, S.J. (2006). Postural control deficits in participants with functional ankle instability as measured by the Balance Error Scoring System. Clinic Journal of Sports Medicine, 16, 203-208.
