Ankle Sprains

Ankle sprains are one of the most common injuries seen in both sport and everyday life, occurring when the ligaments supporting the ankle joint are stretched beyond their normal range or torn. The classic mechanism is the foot rolling inward while the ankle twists — often during sport, but just as commonly from an uneven footpath, a misjudged step off a kerb, or landing awkwardly from a small jump.

Despite how common they are, ankle sprains are frequently under-treated. Many people rest until the pain and swelling settle, consider themselves recovered, and return to activity — only to re-sprain the same ankle weeks or months later. Incomplete rehabilitation, rather than the initial injury itself, is the single biggest reason ankle sprains become a recurring problem.

What causes ankle sprains

Most ankle sprains involve the ligaments on the outer side of the ankle, injured when the foot rolls inward (inversion) — this can happen from stepping awkwardly, landing from a jump on an uneven surface, or a sudden change of direction in sport. Less commonly, the ankle rolls outward, injuring the ligaments on the inner side, or the sprain involves the ligaments higher up between the shin bones (a “high ankle sprain”), which tends to take longer to recover. Previous ankle sprains are one of the strongest risk factors for a future sprain, largely because the balance and proprioceptive function of the ankle — its sense of position and movement — often isn’t fully restored after the first injury.

Ankle sprains are generally graded by severity: a Grade 1 sprain involves mild stretching of the ligament fibres with minimal instability; a Grade 2 sprain involves partial tearing, with more noticeable swelling, bruising and some looseness in the joint; and a Grade 3 sprain is a complete tear, usually with significant swelling and a genuine sense of instability. The grade matters for planning treatment, since a more significant tear generally needs a longer, more structured rehabilitation programme to restore the ankle’s stability before returning to sport.

When to see a physiotherapist

Most ankle sprains can be assessed and managed by a physiotherapist without needing imaging. However, if you’re completely unable to bear weight on the ankle, there’s visible deformity, or pain is felt directly over the bone rather than the ligaments, an X-ray may be needed to rule out a fracture, and this is best done promptly. Significant swelling and bruising, or a sprain that hasn’t improved at all after several days, also warrant a proper assessment rather than continued self-management — the extent of ligament damage isn’t always obvious from how the ankle feels alone.

Physiotherapy treatment for ankle sprains

Treatment is staged according to how acute the injury is. In the first day or two, managing swelling and protecting the ankle from aggravating movements takes priority; beyond that, prolonged rest isn’t necessary for most sprains and can slow the overall recovery. Andrew’s approach typically combines:

• Manual therapy to restore normal joint movement, ease stiffness, and address any restriction that’s developed while protecting the ankle in the early days — often alongside taping or strapping for support during this phase.
• Exercise rehabilitation — a progressive programme rebuilding strength through the muscles supporting the ankle, along with balance and proprioceptive training, which retrains the ankle’s sense of position and is what most reduces the risk of re-spraining.

Even what feels like a “minor” sprain benefits from this fuller programme rather than simply resting until the pain settles, since pain often resolves well before the ankle’s strength and balance have actually recovered.

What to expect from treatment

Andrew’s assessment will identify which ligaments are involved and how significant the damage is, which shapes how quickly you progress through each stage of rehabilitation. Early sessions focus on settling swelling and regaining comfortable movement; as this improves, sessions shift toward the strengthening and balance work that determines whether the ankle holds up once you’re back to full activity.

Recovery timeline

Mild sprains can improve within 1 to 2 weeks, while more significant ligament damage can take 6 weeks or longer to fully rehabilitate — particularly the balance and strength components, which typically take longer than the pain does to settle. Return to sport should be guided by how the ankle is actually performing on assessment — its strength, balance and confidence with sport-specific movements — rather than by pain alone or a fixed timeframe, since returning too early is the main reason ankles keep re-spraining.

Preventing recurrence

Once an ankle sprain has settled, staying on top of the balance and strengthening exercises Andrew builds into your programme is what keeps the joint resilient long-term, since previous sprains are one of the strongest predictors of future ones. For people returning to a sport with a history of ankle sprains, ongoing proprioceptive work — even briefly, a few times a week — and appropriate strapping or bracing during high-risk activity can further reduce the chance of re-injury.