Twisting your ankle by stepping on a curb or coming down the stairs is something almost everybody has experienced at some point. 1 in 10,000 people per day suffer an ankle sprain just in the US.
Ankle sprains are of different intensities. They can be mild without much pain or swelling and they can also be quite severe with a broken bone and extensive damage.
So what should you do after any type of ankle sprain? That’s what we’ll answer in this post.
Keep reading to find out when you need to go see a physiotherapist and what you can do at home to rehab your ankle back to full strength.
What Happens in an Ankle Sprain?
An ankle sprain is an injury to the ligaments, tendons, and muscles (together called soft tissue structures) surrounding the ankle. It happens when you twist your ankle, either inside or outside, in such a way that the soft tissue structures are stretched beyond their normal range.
These structures are arranged in layers, from superficial to deeper ones, each stabilizing the joint from a different angle.
All the light blue/gray lines you see in the image are ligaments crossing from one bone to the next and stabilizing all the joints of the foot and the ankle.
There are different grades of an ankle sprain and it depends on how severe the damage is. Deeper structures of your ankle get involved with more severe injuries.
| Swelling | Tenderness | Pain | Possibility of Fracture | Recovery Timeline | Need for PT | |
|---|---|---|---|---|---|---|
| Grade 1 | Minimal – for 24 Hours | Yes | Yes (upon weight bearing) | No | 2-3 weeks | No |
| Grade 2 | Moderate – Upto 48h | Yes | Yes | No | 4-8 weeks | Yes |
| Grade 3 | Significant- up to 48 hours | Yes | Yes | Yes | 12 weeks | Yes |
Physiotherapy for a Sprained Ankle
The physiotherapy treatment for an ankle sprain begins with an examination of the joint. We use multiple tests depending on the severity and the mechanism of the injury. Here are some of those that you can do at home in case of grade 1 or grade 2 ankle sprain:
Anterior Drawer Test: With the patient’s knee slightly bent, hold the heel of the foot in one hand and stabilize the lower leg. Pull the heel anteriorly towards you. Do the same on the healthy side. You should compare the level of movement of both feet. If there’s a ligament rupture or chronic instability, then the injured foot will move anteriorly more than the healthy foot, indicating the ligament’s laxity.
External Rotation Test: Bring your foot up or in the neutral position. Move it outwards (laterally) while stabilizing the lower part of the leg. A positive sign is the reproduction of pain along the anterior and center of the ankle.
The purpose of this assessment is to determine which structures are involved and diagnose the grade of an ankle sprain. A good assessment is vital for designing an accurate treatment plan.
Overview of What Physio for a Sprained Ankle Includes
Treatment begins with restoring the range of motion of the ankle through exercises, then allowing weight bearing on it for daily activities, and finally stabilizing the joint by strengthening the ligaments and muscles of the ankle, calf, and foot.
Here are some exercises we use for each step of physiotherapy rehab for a sprained ankle:
- ROM and Elevation
In the first few days, you should only perform Range of Motion (ROM) exercises in painless ranges i.e. move the ankle up and down and in circles only to the point that it doesn’t cause you pain. A slight discomfort or stiffness is fine and nothing to worry about.
Avoid standing for too long when there’s swelling and pain, which usually lasts for a couple of days after an ankle sprain.
Since our lower body structures tend to swell up a lot more, elevate your ankle when you know you’ll be sitting for a long time, but only while it’s swollen in the first week or so.
- Appropriate Loading
You can begin to put weight on your ankle when the swelling starts to go down a bit and you’re in less pain.
Use your pain level as a guide of how much weight you should bear. Begin with partial weight bearing by pushing your foot into the ground while standing only as much as you can manage. Hold on to a railing or some support to decrease the weight on the injured leg.
You can also do this while sitting (on the floor or a low chair) by applying pressure on your ankle but keeping most of your body weight on your hips and not on your legs (because you’re sitting).
Your physiotherapist may recommend wearing a brace while performing high-impact activities, such as hiking with a healing ankle.
We also use taping (Kinesio taping or dynamic taping) to stabilize the sprained ankle in severe sprains or with recurrent sprains. (Reference)
The purpose of doing this is to prevent your foot from everting (going outwards) or inverting too much. Preventing excessive movements is the ligament’s job but while they heal, having additional support doesn’t hurt.
Frequently Asked Questions About Physio for a Sprained Ankle
Here are the answers to questions you might have about recovery after an ankle sprain.
How Long Does an Ankle Sprain Take To Heal?
The duration of rehab after an ankle sprain depends on multiple factors such as the extent of injury, structure involved, condition of the muscles, posture, ankle anatomy, gender, and body weight. (Reference)
You have to avoid complete rest during any of the rehab stages. Feel free to apply ice but only to reduce pain. If your pain level is low, then avoid the ice pack to allow the natural inflammatory process to happen.
Your ankle swells up after a sprain because the body sends its “cleaning crew” (macrophage cells that remove the broken tissue from an injured site) to the area and this crew is the primary cause of the swelling.
The quicker your body can clean the debris out of the injured area, the quicker the macrophages will move out and inflammation will go down. Icing essentially pauses this process and thus delays it.
Do I Need to Visit a Physiotherapist for an Ankle Sprain?
Not really, unless you’re an athlete, suffer from chronic ankle instability, are elderly, or have some extenuating circumstances that require you to seek an expert’s help.
But a visit to the physiotherapist doesn’t hurt. You’ll get a professional to assess you and prescribe you a tailored rehab program so you’ll have the peace of mind to move on from the injury.
Many people become fearful to put their entire weight on the ankle or wear heels after a sprain. A PT can help you gain your confidence back by challenging your body (in due time) by having you perform various exercises.
They can also help you avoid compensatory movements which are not a big issue on their own for regular folks but these can become a problem if the movements put additional load on other joints.
For example, suppose you have knee arthritis and start walking differently after an ankle sprain such that one side of the knee takes on more load now. That could easily aggravate arthritis and make your pain worse.
Our bodies are incredibly adaptable and a slight change in your movement pattern, flexibility, or range of motion isn’t something to worry too much about. But developing compensatory movement patterns is a slippery slope so it’s best to be proactive and avoid them rather than correct them afterwards.
If your recovery timeline is complete (based on your level of injury) and you still can’t bear your entire body weight on your ankle or if it feels unstable, then you should consult a physiotherapist and get an expert assessment done. We can help pinpoint the exact factors that might be delaying your recovery and create a program targeting those factors, regions, movement patterns or structures.
What Happens if My Ankle Sprain Heals Incorrectly? Or if I Load It Too Soon?
The biggest risk after an ankle sprain is insufficient healing, which weakens the joint and leads to further injuries. (Reference)
For instance, ligaments become more flexible than before after an injury. (Reference) They also take much longer to heal than muscles. So while they’re healing after an ankle sprain, the stability of the joint is compromised and you’re at risk of recurrent injuries.
It’s usually not a major concern because these tend to strengthen over time. But it can become a problem if your routine activities require good ankle stability because then you’ll be vulnerable to another sprain, even under a minor load.
The ankle joint is surrounded by multiple ligaments and these are the primary structures that suffer in an ankle sprain. If you don’t strengthen them properly, which often happens with unsupervised rehab, then you’re left with a weaker ankle.
Ankle sprains have incredibly high re-injury rates. 12% to 47% of all reported ankle sprains are recurrent. And nearly 70% develop chronic ankle instability afterward.
Loading the joint too soon can cause another injury. Multiple studies have shown that returning to play prematurely or loading too much too soon causes more harm than good. (Reference)
What Is the Best Treatment for a Sprained Ankle?
Adequate rest, gentle exercises, and progressive loading are excellent for treating ankle sprains through physical therapy. (Reference)
You should stimulate your ligaments to heal in the right direction while they’re in the recovery phase and malleable. You can do that with appropriate loading based on your pain levels.
Keeping the joint mobile with gentle ROM exercises is necessary to prevent the pooling of fluids and blood around the joint. It also helps prevent stiffness and keeps the muscles active.
The Takeaway
Although ankle sprains are a common injury, they often require a structured rehab program, one that a physiotherapist can help you with.
Most ankle sprains heal at home with proper care, as explained in this article.
You can examine your ankle at home to diagnose the structures that are injured and then perform the required exercises to make your ankle healthy again.
Instead of memorizing one or two specific exercises for all kinds of ankle sprain, you should understand the goals of rehab, which are to improve ROM and stability. That way, you can modify exercises as you please as long as they help you achieve your goal of a stronger stabilized joint.
Struggling with your ankle sprain rehab? Contact us to get a personalized recovery program.