Ankle Sprain

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What Is an Ankle Sprain?

An ankle sprain occurs when an ankle rolls, turns, or twists in a way it isn’t meant to. This can stretch or tear the ligaments. Ligaments are tissues that attach bone to other bones, keeping our joints stable.  Most injuries, known as lateral ankle sprains, occur on the outside of the ankle. The less common type, known as a medial ankle sprain, occurs on the inside of the ankle.

The main symptom is pain, especially when bearing your body weight through the leg. Other symptoms include swelling, bruising, and loss of ankle movement and strength. 

Treatment for a sprained ankle and duration of healing depends on how severe the injury is. 

What Are the Grades of Ankle Sprains?

Grade 1, Mild:

The ligament fibres have been stretched slightly. There is some tenderness and swelling. The ankle is still considered stable; however, there is point tenderness to touch and stress the ligament.  

Grade 2, Moderate:

The ligament is torn, but it isn’t a complete tear. There can be complete tears of some but not all the collagen fibres in the ligament. There is very likely ankle instability,  moderate pain, tenderness, swelling, and decreased range of motion as well.

Grade 3, Severe:

The ligament is torn completely. Your ankle has significant swelling, pain, and loss of movement. Everyday tasks are very difficult. 

Typical Physiotherapy (PT) & Athletic therapy (AT) treatments for all grades of ankle sprains have similarities and differences.

PT & AT Treatment for all grades of ankle sprains aim to:

  • Increase the ankle’s range of motion (movement).
  • Increase joint mobility through the various joints of the ankle, as well as above and below the ankle, if needed. 
  • Reduce swelling, pain, and muscle spasm or tightness.
  • Improve strength and balance.

Physiotherapy and/or Athletic Therapy can be done with:

  • Manual therapy (“hands-on” treatments such as joint mobilizations, soft tissue release, passive stretching, and muscle energy techniques, etc.). 
  • Modalities can be used well, such as:
  1. Ultrasound (reduces swelling and breaks up scar tissue). 
  2. Acupuncture (reduces pain & inflammation). 
  3. Ice (reduces swelling and pain).
  4.  Exercises addressing increased range of motion (movement of the ankle), strength, & balance.

Differing rehabilitation protocols for Grades 1, 2, & 3 ankle sprains:

  • Grade 1 ankle sprains typically do not need splinting or casting. Grade 1 ankle sprains usually allow return to sports at 2-3 weeks post-injury.
  • Grade 2 ankle sprains require immobilization with an air splint. Grade 2 ankle sprains typically allow return to sports at 4-6 weeks post-injury.
  • Grade 3 ankle sprains require immobilization with an air splint for a longer amount of time. Grade 3 ankle sprains are much more severe and typically allow the return to sports at 3 months+ post-injury.

Ankle Range of Motion Exercises

These types of exercises should begin right after your injury. Try doing these exercises and then putting ice on your ankle. Do this up to 5 times a day. These are easy to do, and you can do them while seated. They really help to improve movement but mostly assist in the reduction of swelling of the ankle.

Ankle ABCs

  1. Sit in a chair with your foot, ideally above the level of your heart. This helps to optimize the reduction of ankle swelling.  You can also do this exercise lying on your back with your affected leg propped up on a pillow).
  2. Slowly trace the letters of the alphabet. Aim to do this 5x/day.

Ankle Stretching Exercises

Start stretching your calf as soon as you can do so with minimal pain. This can be performed seated (see Photo A). This is easier as your leg isn’t bearing your body weight. If you need a bigger challenge, try the traditional standing calf stretch (second photo). Performing another 2 sets of 10 with the rear knee bent will help the smaller calf muscles lower in the leg. Calf stretches should be performed daily. 2 sets of 10 holding for 20 seconds. 

Calf stretch (seated, knee straight)

Photo A

  1. Sit on the floor with your affected leg straight and resting on the floor.
  2. Place a towel around your affected foot.
  3. Hold one end of the towel in each hand.
  4. Pull back gently with the towel so that you feel a stretch in your calf.
  5. Hold the position for 20 seconds.
  6. Repeat 10 times, 2x/day.

Standing calf stretch (standing, knee straight)

*The affected leg is behind. Keep the toes pointed forward and the heel touching the ground.

Calf Stretches: Improve Your Flexibility - Knee Pain Explained

Ankle Strengthening Exercises

Your Physiotherapist or Athletic Therapist will guide you on the timing of strengthening exercises for the ankle, and likely start them with you when you are able to stand without increased pain or swelling.

Ankle eversion +/- TheraBand:

  1. Sit in a chair with your affected foot flat on the floor and next to a wall or a piece of furniture that doesn’t move.
  2. Push your foot outward against the wall or piece of furniture.
  3. Hold for about 5 seconds, and then relax.
  4. Do 3 sets of 10 repetitions.

*After you feel comfortable with this, try using an exercise band for resistance instead of a wall. Tie a loop on one end of an exercise band or hold both ends of the band in one hand. Put the loop around the outside of your affected foot and then step on the band with your other foot. Push your affected foot out to the side against the band, count to 5 then slowly bring your foot back to the midline. 

Ankle Balance and Control Exercises

You can usually start balance and control exercises when you can stand without pain. But your Physio and/or AT will tell you when it’s safe. Also, if a practitioner is not supervising you, don’t try these exercises if you couldn’t have done them easily before your injury. If you think you would have felt unsteady doing these exercises when your ankle was healthy, you risk falling if you try them with an injured ankle.

Single-leg balance

  1. Stand on a flat surface with your arms stretched out to your sides like you are making the letter “T.” Then lift your good leg off the floor with a slight bend at the knee. If you are not steady, use one hand to hold on to a chair, counter, or wall with the least number of fingers needed.
  2. Standing on your affected leg, keep that knee straight. Try to balance on that leg for up to 30 seconds, and then rest.
  3. When you can balance on your affected leg for 30 seconds with your eyes open, try to balance on it with your eyes closed.

     4.  Do 3 sets of 10 repetitions.

**When you can do this exercise with your eyes closed for 30 seconds with ease and no pain, try standing on a pillow or piece of foam.


It’s crucial to follow a physical therapy treatment for ankle sprain recovery. Contact us today!

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