Ankle Sprain – Step by step Treatment Guide




Spraining an ankle can be very painful. Ankle sprains is one of the most common sport injuries. According to Brunker and Khan Sport medicine it is ranked the number one sport injury in 24 different types of sports. Research shows that if you don’t treat it correctly an ankle sprain can sometimes develop into a “problem ankle”. It is thus very important to treat every sprain correctly. In this article we will give you a step by step guide what to do from the actual injury to 6 weeks post injury.

How do I know if I sprained my ankle?

The mechanism of injury gives us many clues to diagnose an ankle sprain. Ligament injuries normally occur in activities that require directional change or  jumping especially on a uneven surface.  If the injury happens with the foot inverted (foot twisted in) their is probably a lateral ligament sprain. If the injury happens with the foot everted (foot twisted outside) a medial ligament injury is suspected.

The onset of pain is also very important to note. A history of being able to weight-bear immediately after an injury followed by a subsequent increase in pain and swelling as the patient continues to play sport or walk about, suggest an sprain (ligament injury) rather than a fracture.

The patient may recall an audible snap, crack or tear when they injured themselves. Swelling usually appears rapidly but sometimes it can be delayed for a couple of hours.

What to do the first 48 hours post injury?

If you treat an ankle sprain correctly the first 48 hours you will lay the foundation for a speedy recovery.

Its therefore important that you practice the RICE regime for the first 48 hours.

RICE Regime:

REST – The injured tissues need time to recover. So, avoid walking on the ankle and try to use crutches if you can.

ICE – This will help with the pain as well as the swelling. Put it 20 minutes on and 20 minutes of.

COMPRESSION – Apply a bandage around the ankle that will compress the area slightly. Be careful not to don’t cut off the blood supply.

ELEVATION – Elevate the foot with pillows. This will help to drain the swelling.

This essential treatment approach helps with swelling and limits the hemorrhage.  If there is too much swelling it can cause an delay the healing process, causing an irritated painful joint that is very restricted in range of motion. The injured person must avoid factors that promote blood flow to the area such as hot showers, heat rubs and excessive weight – bearing.


1) There is moderate to severe swelling

2) You can’t weight bare on the foot

3) When the foot feels mild to moderate unstable

4) If you heard an audible snap/ crack/ tear

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1) There is severe swelling

2) You can’t weight bare at all

3) When the foot feels very unstable

4) When the your ankle is dislocated or if you suspect a fracture.

What to do after 48 hours post injury?

Ankle sprains can take anything from 3 weeks to 6 weeks to heal. After 48 hours its best to:

1) See your physiotherapist

Physiotherapists can do some tests to determine how severe the ankle sprain is. In a grade I tear there is no abnormal ligament laxity. In a grade II tear there may be some  degree of laxity but with a firm end point. A grade III tears show gross laxity without a discernible end point. All grades are associated with pain but the grade III tear may be least painful after the initial episode has settled.

Treatment will start with gentle soft tissue mobilizations techniques to reduce pain and promote healing. Modalities like ultrasound, dry needling or laser can also be helpful to reduce swelling and pain and promote healing. Strapping the ankle can help to help protect the injured tissue to avoid further damage. Your physio will give some early rehabilitation exercises.

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2) Strap the ankle or use a brace.

Click on the link below to see how you can strap your ankle at home. Please share this blog to make the video content available.

3) Start with gradual weight bearing.

Gradually increase the weight- bearing on the ankle. Please respect pain at all times slowly work your way off he crutches. If you are uncertain you can ask your physiotherapist.

Rehabilitation exercises.

Rehabilitation exercises focus on:

  • Restoration of full range of motion – as soon as the pain allow it the patient should start with active rage of motion exercises and weight bearing exercises. The sooner one can restore full rage of motion the faster the muscles will return to their full strength.
  • Muscle conditioning – Active strengthening exercises in all directions of the ankle joint should be commenced as soon as pain allows it.
  • Balance (proprioception) exercises – Balance exercises is important for strengthening as well as injury prevention in the future. If there is not adequate balance the ligament can be easily injured again.
  • Functional exercises. Jumping, hopping, twisting and figure-of-eight running can be started when there is no pain, good balance and there is full range of motion. Specific technical training not only accelerates return to sport but also significantly reduce the risk of re-injury.

For an ankle rehabilitation program please click on the link below. Please share this blog to unlock the program.

Ankle Rehab Level 1

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Written By: Adrien Dannhauser