Ankle Sprains: What Happens and What to Do Next

The ankle is stabilised by a network of ligaments, and a sprain occurs when the foot rolls or twists beyond the joint's usual range, stretching or partially tearing one or more of them. The most common type involves the ligaments on the outer (lateral) side of the ankle, typically when the foot rolls inward during a misjudged landing, a change of direction, or an uneven surface.

It's a remarkably frequent injury, occurring in sport, on staircases, on cobblestones, and sometimes simply while walking. For many people, the immediate response is to wait for the swelling to subside and assume the job is done. But the rehabilitation phase, which many skip, may be just as important as the initial rest.

Understanding the grades

Ankle sprains are generally described in three grades. A grade one involves mild stretching of the ligament fibres with minimal swelling and usually allows weight-bearing relatively quickly. A grade two involves a partial tear, more significant swelling and bruising, and a longer recovery period. A grade three is a complete rupture of the ligament, often with substantial swelling, bruising, and instability, and typically warrants professional assessment to determine the right management approach.

The degree of bruising and swelling can be quite dramatic even in moderate sprains, and many people find it reassuring to have the injury properly assessed rather than guessing where on the spectrum they are.

The ligament heals, but without the right rehabilitation, the ankle's balance and proprioception may not fully return, leaving it vulnerable to future sprains.

The first 48 to 72 hours

The current guidance has shifted somewhat from the older "RICE" framework (rest, ice, compression, elevation) towards an approach known as POLICE or more recently PEACE and LOVE, which emphasise that complete rest may not always be optimal and that some gentle loading could actually support tissue healing. In practice, this means protecting the ankle from further injury, elevating it to reduce swelling, and introducing gentle, pain-free movement fairly early rather than waiting for all swelling to subside before doing anything.

Ice may help with comfort and managing swelling acutely, though the evidence on its long-term effects on healing is more mixed than commonly assumed. Compression bandaging and elevation in the early days can help keep swelling manageable, which in turn may allow earlier movement.

Why rehabilitation matters so much

The ligament itself may repair over several weeks, but the ankle's neuromuscular control, its ability to sense its own position in space and respond to instability, can be significantly disrupted by a sprain. This is known as proprioception, and without targeted rehabilitation to restore it, many people are left with an ankle that feels "wobbly" or that gives way under them, making further sprains more likely.

Balance exercises, progressive strengthening, and sport-specific movement patterns are the cornerstones of a good ankle rehabilitation programme. Many people who experience repeated ankle sprains find that they never fully addressed this phase after their original injury.

When to get it looked at

If you cannot bear weight at all in the first few hours after a sprain, if the pain is severe and localised over the bone itself, or if swelling seems disproportionate, it could be worth having the ankle assessed to rule out a fracture. The Ottawa Ankle Rules are a set of clinical guidelines used to determine when an X-ray might be appropriate, and a physiotherapist or sports medicine practitioner could apply these in assessment.

Even for sprains that seem straightforward, working with a physiotherapist to move through a structured rehabilitation process might significantly reduce the chance of future injury and get you back to sport feeling more confident in the ankle's stability.

Ankle sprains have a reputation for being minor, and often they are. But giving the recovery process the attention it deserves, especially the rehabilitation phase, could make a meaningful difference to how the ankle holds up for everything that comes after.