Ankle Sprains. What do you damage when you sprain your ankle?

There are three main kinds of ankle sprains that injure different ligaments.

Your classic rolled ankle is an inversion or lateral/low ankle sprain, which will injure your ATFL and/or CFL ligaments.

You can also do a high ankle sprain (also sometimes called a syndesmosis injury). This injury usually happens when you go to turn while your foot is planted, or during an awkward tackle. This injures you AITFL and can also injure your syndesmosis – a long band of connective tissue between your tibia and fibula. These injuries tend to take longer to heal than inversion sprains.

The third main type of ankle sprain is an eversion or medial ankle sprain where your ankle rolls the other way which injures the ligaments in the inner side of your ankle – your deltoid ligament. This type is much less common and often happens as a contact injury or tripping on a step. These injuries tend to be more severe than an inversion sprain and take longer to heal.

Ankle sprains also vary in severity from a grade 1 strain (only slight damage to the ligaments) to a grade 3 tear (full rupture of the ligaments).

Do I need a scan?

Your physio will assess your ankle to see if they think a scan is necessary.

You can sometimes fracture the bones in your foot and ankle when you roll your ankle and if we suspect this, we will send you to get an x-ray.

We sometimes recommend an MRI if we’re worried about a syndesmosis injury or if you want to know the severity of the sprain so we can better estimate how long it will take for you to return to sport, however, this is usually not needed.

How long will it take?

A grade 1 ankle sprain can recover within a week or two, while grade 3 ankle sprains can take up to 3-6 months. This is why we use tests to determine if you’re ready to return to sport rather than time-frames, as different ankle injuries have vastly different recovery times.

What should I do now?

SEE A PHYSIO! Don’t just say “She’ll be right”. Yes, you will get better. Yes, the pain will ease. Yes, you will get back to the sport, but the damage to the balance receptors won’t be repaired and you’ll probably roll it again! The sooner you see a physio, the sooner your ankle will be back to 100%.

We see too many people who only come in WEEKS after their injury and by then their ankle is so stiff that rehab takes even longer! With many of these people, if they’d come in the day after it happened, they’d be most of the way through rehab by the time they eventually come in!

ICE? RICE? POLICE? What’s the go now?

The latest acute injury acronym is PEACE & LOVE. PEACE is what you should do now and LOVE outlines the rehab process:

Protect (stop what you’re doing, boot, crutches, etc as necessary for a few days)
Avoid anti-inflammatories (ice, Voltaren, Nurofen, etc)
Education (about the rehab process)


Load (rehab exercises)
Optimism (a positive attitude to rehab and restoring your confidence in the ankle)
Vascularisation (fitness)
Exercise (gym, training, sports drills)

The main change here is that ICE AND ANTI-INFLAMMATORIES ARE NOT RECOMMENDED because it’s actually important to allow some swelling to occur, as this is how your body starts the healing process. Ice also numbs your pain which will make you more likely to do too much with the ankle and risk hurting it more. Some studies have shown that anti-inflammatories can reduce the integrity of the ligament at around 4-6 weeks after your injury, right when you’re returning to sport. So they might make you feel better quicker, however going back too soon with poor ligament integrity and no strength training is a recipe for disaster.

You’ll also notice REST isn’t on the list anymore. That’s because you need to keep your ankle moving from day 1. Without this, your swelling will pool around your ankle and foot which restricts mobility and then will slow recovery. For the first few days, active recovery means pumping your ankle literally 100’s of times a day. This helps to remove the swelling from your ankle and pump new blood with all the healing cells and chemicals in. Think, pumping good stuff in and pumping bad stuff out. This will reduce inflammation and maximise the healing response rather than just stopping the healing response altogether as anti-inflammatories will.

I love the fact that rehab is now included in the injury management acronym, it really emphasises how important proper physio treatment is to get you back to 100%!

What do I need to do long-term?

Rehab, rehab early, rehab properly.

What will rehab look like?

1. Mobility

In the early days, we’ll work on decreasing the swelling, getting you walking comfortably and maintaining the movement in your ankle to stop it from getting stiff.

If your ankle is already stiff, we’ll work on increasing the movement in it through hands-on treatment and exercises for you to do at home.

2. Balance

Balance is another really important thing to work on early. Our ligaments play an important role in sending messages to our brain about how our joints are moving. When you injure a ligament, these messages get interrupted. By training balance, we strengthen these messages so that if you go to roll your ankle again, your brain can feel that movement and correct it before it goes far enough to do damage.

3. Strength

We’ll start strength work early – strengthening your calf, the muscles in your feet, and the muscles that stop you from rolling your ankle.

We’ll also give you some exercises to maintain strength throughout the rest of your body so that you’ll still be strong when you go back to your sport.

4. Agility and Power

Part of teaching your ankle and body to react and adjust quickly is training agility. This will start off with things like hurdle hopping and obstacle courses and will progress into sport-specific training drills.

5. Fitness

As you progress towards returning to the sport, we will push your strength and conditioning more to prepare your body to get back to playing. We’ll walk you through a running program, then get you joining in with parts of training, doing more as your ankle gets stronger.

6. Confidence

One of the most underrated aspects of rehab is making sure you’re confident before going back to the sport. In a game, there’s so much going on and if you’re worried about hurting your ankle again, you’ll move differently and it’s likely you’ll hurt it again or injure something else.

We have tests that will help us see how confident you are, but it’s important that you’re honest with us about this as, at the end of the day, you’re the only one who knows how confident you feel on your ankle. Outside of our testing, confidence is the biggest indicator of re-injury risk.

Now, come with me in video-form through my ankle rehab to give you an idea of what your journey might look like:


Manual therapy:


Getting your muscles firing again as early as possible is also critical, so we’ll begin using and strengthening the muscles in your foot and calf as soon as pain allows.

Mid stage:

Mid-stage rehab is where the strength work will really ramp up – using weights if possible to BUILD strength. You’ll also begin some hopping to test the ankle before being given the green light to start running.

Late stage:

AGILITY – this is where we’ll really test your ankle and uncover any weaknesses. We’ll also get you back into modified training, working towards full training and game-time.


Now what?

After you’ve been through the acute phase you only need to do maintenance drills 1-2 times per week to get the continued effects of preventing a re-roll. This is huge as often a couple of simple drills done at training twice a week is more than enough to stop re-injury.


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