Ankle Sprain Recovery: Why "It's Just a Sprain" Isn't the Whole Story | Physiotherapy & Beyond

Ankle Sprain Recovery: Why "It's Just a Sprain" Isn't the Whole Story

Almost everyone has rolled an ankle at some point. You step off a curb wrong, land on someone's foot in a pickup basketball game, or catch the edge of a root on a trail. There's a sharp pain on the outside of the ankle, some swelling by evening, and usually the same conclusion: it's just a sprain, it'll get better on its own.

In the short term, that's often true. Most ankle sprains settle down enough to walk on within a week or two. What I see in the clinic, though, is what happens months or years later. A sizeable share of people who sprain an ankle go on to have ongoing pain, a feeling that the ankle "gives way," or repeat sprains. We call this chronic ankle instability. It's common, and much of it can be prevented.

The most typical sprain happens when the foot rolls inward, stretching or tearing the ligaments on the outside of the ankle. The ligament that takes the brunt is usually the anterior talofibular ligament. When it's injured, you lose more than some passive support. Ligaments are full of sensors that tell your brain where your joint is in space. After a sprain, that signalling is disrupted, your balance and reaction time drop, and the muscles around the ankle don't fire as quickly as they should. That's why the ankle can feel wobbly long after the swelling is gone, and why the next roll comes so easily.

The first question after a bad sprain is usually whether it's broken. Here's a helpful tool with Canadian roots: the Ottawa Ankle Rules, developed at the Ottawa Hospital, help determine who actually needs an X-ray. Tenderness over specific spots on the ankle and foot bones, or being unable to take four steps both right after the injury and when you're assessed, are signs that imaging is warranted. If you can't bear weight at all, have obvious deformity, or have numbness in the foot, get it checked promptly.

For the first few days, the goal is to protect the ankle without shutting it down. Elevation and gentle compression help manage swelling. Beyond that, the thinking has shifted over the years. Complete rest and long periods in a boot are rarely necessary for a typical sprain. Research consistently shows that early, guided movement and gradual weight-bearing lead to better outcomes than immobilization. Pain is a useful guide: some discomfort is acceptable, but sharp pain that lingers after activity means you've done too much.

This is where physiotherapy earns its place. Early on, we work to restore range of motion, especially the ability to bend the ankle upward, which is often stiff after a sprain and changes how you walk, squat, and run. Then we rebuild strength in the calf and the muscles along the outside of the lower leg. The part people most often skip is balance training. Single-leg balance, progressing to unstable surfaces, eyes closed, and sport-specific hopping and cutting, retrains the reflexes the ligament injury disrupted. Structured balance and neuromuscular programs have good evidence for reducing the risk of re-injury, and they're the piece I'd least want anyone to leave out.

Returning to sport should be based on how the ankle performs, not just how long it's been. Can you hop on it repeatedly without pain? Land and change direction confidently? Match the other side on balance tests? For some athletes, a brace or tape during the first season back offers extra protection while the ankle finishes adapting.

Not every sprain is the same. A "high ankle sprain," which involves the ligaments joining the two lower leg bones, usually takes considerably longer to recover, and it's worth having assessed if your pain is above the ankle joint or worse with twisting.

If you've sprained your ankle recently, or you've been living with one that never quite felt right, our team can assess it and build a plan that gets you back to what you enjoy. You can reach us at 905-278-7101 or care@physiotherapyandbeyond.com.

Fady Rofail, PT, DPT

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