Ankle sprain: symptoms, treatment, and physical therapy
- Ricardo Vargues - Fisioterapeuta
- Mar 7, 2023
- 5 min read
Updated: Feb 7
Ankle sprains are one of the most common injuries in everyday life and in sports — and also one of the most underestimated. When they’re not treated properly, the risk of chronic instability, persistent pain, and recurrent sprains increases.
In short, what to do in the first 48 hours:
In the first 48–72 hours, the goal is to control pain/swelling and return to weight-bearing safely (without “pushing through it”).
Not every sprain requires an MRI — your doctor will decide, and an X-ray is mainly ordered when there’s suspicion of a fracture.
Rehab with exercise (strength + balance/proprioception) is what most reduces re-injury.
When does an ankle sprain happen?
A sprain happens when the ligaments are forced beyond their capacity, usually through an inversion mechanism (the foot “rolls inward”), most often affecting the lateral ligament complex.
Grades of ankle sprain:
Grade I: mild stretching (pain and swelling are more manageable).
Grade II: partial tear (more swelling, bruising, and limitation).
Grade III: complete tear (marked instability; may require initial immobilization and thorough evaluation).
Important note: In clinical practice, severity doesn’t depend only on the “grade” but also on function (how well you can bear weight, walk, balance, and regain mobility).
Typical symptoms (and warning signs)
The most common symptoms include pain, swelling/edema, possible bruising, increased local warmth, and difficulty walking.
Seek urgent medical evaluation if there is:
Inability to bear weight or take 4 steps.
Very localized bone pain (around the ankle bones, the base of the 5th metatarsal, or the navicular).
Deformity, loss of sensation, pain that feels wildly out of proportion, or suspected fracture.
Do I need an X-ray? (and when does an MRI make sense?)
A lot of people hear “sprain” and assume they always need imaging. In reality:
When is an X-ray most appropriate?
Your doctor may use clinical decision rules to determine whether an X-ray is needed, helping avoid unnecessary imaging without missing clinically important fractures.
What about an MRI?
An MRI is usually reserved for specific situations (e.g., suspected more complex injury, pain/swelling that isn’t improving as expected, or when structural clarification is needed). The key point is: don’t delay rehab just because you haven’t had an MRI, as long as there are no red flags.
What to do in the first 48–72 hours (acute phase)
The initial goal is to protect the ankle, reduce symptoms, and progressively restore function. Some current recommendations for soft-tissue injuries prioritize education, progressive loading, and exercise — rather than “stopping everything” for weeks.
What usually helps:
Protection + compression + elevation (especially in the first 48 hours).
Progressive weight-bearing with support (crutches) if needed.
Gentle mobility (without strong pain) to prevent stiffness.
Ice may help with pain relief for some people (not “mandatory”; use if it makes sense for you).
Medications (painkillers/anti-inflammatories) only with medical guidance, especially if you have other medical conditions.
Why “waiting it out” is a mistake
A significant percentage of people develop persistent symptoms (pain, a feeling of an “unstable” ankle, and repeat sprains) when there isn’t a well-structured rehab plan.
How physical therapy helps (what I do in practice)
The strongest guidelines recommend active rehab, with criteria-based progression and a focus on strength, neuromuscular control, and functional return.
Goals by phase
1) Pain/swelling and walking
Reduce swelling and improve tolerance to weight-bearing.
Restore a safe walking pattern.
2) Mobility
Restore dorsiflexion and ankle mobility (key for stairs and running).
3) Strength
Strengthen all key muscles: calf/soleus, peroneals, tibialis anterior, and the hip chain (yes — the hip influences foot control too).
4) Balance and proprioception (the “anti-relapse” part) Proprioception/neuromuscular training programs reduce recurrence and improve function.
5) Return to sport (for athletes)
Functional testing (hops, change of direction, balance)
Training progression and, when appropriate, taping/brace in early return phases to reduce risk.
Simple early-stage exercises I often use*
*These don’t replace an assessment — they’re common examples when there are no red flags.
Gentle passive/active mobility.
Pain-free flexion/extension.
Calf raises (progressive, as tolerated)
Single-leg balance (start near support; progress gradually)
Practical rule: mild discomfort can be okay; pain that ramps up a lot or feels “worse the next day” means you should scale back.
Recovery time: how long does it usually take?
It varies with grade, function, and rehab consistency. A commonly used clinical reference:
Grade I: ~5–14 days.
Grade II: several weeks (often 3–6).
Grade III: can take 8–12 weeks or more and needs a well-guided rehab plan.
Prevention: How to avoid another sprain?
The best prevention is complete rehab:
Balance/proprioception training (reduces recurrence)
Criteria-based return to sport (not just “it doesn’t hurt anymore”)
Taping/brace in some cases/phases (especially with a history of sprains)
Appropriate footwear and well-managed load progression
How can I help (in-home physiotherapy in Lisbon)?
If you’ve sprained your ankle and want to recover safely, I can help with:
A complete assessment (pain, mobility, strength, balance, walking)
A progressive plan with clear goals (e.g., walk pain-free, return to running, return to sport)
➡️ In-home physiotherapy: see how it works here.
➡️ Quick booking: book now.
FAQ
1) How long does it take for an ankle sprain to heal?
It depends on grade and function: it can range from 1–2 weeks (mild) to several weeks/months (severe).
2) Should I use ice on a sprain?
It can help relieve pain for some people, especially early on. The key is managing pain/swelling and starting progressive rehab.
3) Do I always need an MRI?
No. Your doctor decides based on signs/symptoms; often it starts with a clinical exam and, when indicated, an X-ray.
4) Why does the ankle feel “weak” after a sprain?
Because strength, neuromuscular control, and balance decrease. Proprioception training reduces recurrence.
5) Does taping or a brace help?
In some cases — especially if you’ve had repeated sprains — they can reduce risk during return to sport.
Conclusion
An ankle sprain is common, but it shouldn’t be left to chance. With active rehab, well-guided progression, and a focus on balance and strength, recovery is usually faster and relapse is less likely.
Want to start with a clear plan? Book your assessment.
Ricardo Vargues | Physical therapist
Watch the video about ankle sprain:
References:
Clinical Practice Guideline: Lateral Ankle Sprains – Revision 2021 (JOSPT/Orthopaedic Section).
Ottawa Ankle Rules (redução de RX desnecessários, elevada sensibilidade).
Dubois B, Esculier JF. PEACE & LOVE (continuidade de cuidados em tecidos moles).
Hupperets MDW et al. Proprioceptive training reduces recurrences (BMJ).
Dizon JMR et al. External ankle supports reduce sprains (JSAMS).
Ferran NA, Maffulli N. Lateral ankle sprains account for ~85% (PubMed).
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