An sprain is an injury that occurs when you over-stretch and tear a ligament, causing damage and pain to the structure. Ankle sprains are one of the most common injuries people experience, both in sport and outside of sport, with approximately 80% of people experiencing an ankle sprain during their lifetime (Bergman, Li & Shuman, 2025; Sports Medicine Australia, 2025). While the majority of ankle sprains will self-resolve, proper assessment and treatment are important to ensure there is no significant damage or ongoing deficits in ankle function.
Lateral ankle sprains (the outside of the ankle) account for roughly 80% of all ankle sprains, as the ligaments through this area are smaller and weaker than the other ligament groups around the ankle (Gaddi et al., 2022). Damage to structures such as the Deltoid ligament (inner ankle) or the AITFL (the ligament that connect the two lower leg bones together at the bottom) can cause more significant problems to the function of the ankle, and around 15% of people who suffer an ankle sprains also have an associated fracture (Gaddi et al., 2022).
- Ligaments are tissues that connect bone to bone, and provide stability and structural integrity to joints.
- If you have recently rolled your ankle which is causing significant pain or a limp, you should have it assessed by a health professional to check for fractures, significant ligament damage, or joint laxity
- If you have had an ankle sprain in the past, and it feels like your ankle never fully recovered, it feels ‘wobbly’, or you have ongoing pain, you may be experiencing chronic ankle instability. This is a condition which can be treated by specific rehabilitation targeting identified deficits.
You should see a health professional if:
- You were unable to put weight through the foot immediately after the injury
- There is visible deformity to the ankle
- You are experiencing significant pain
- Pain or swelling are persisting or worsening following the injury
- It feels like your ankle never fully recovered after an injury
- You keep spraining your ankle
All ligament injuries use a basic grading of 1-3 to determine the severity of the injury.
Grade 1: A minor injury involving microscopic tears to the ligament. There will be mild pain which is worsened with activity, and potentially some swelling, however there will be no laxity or instability of the ankle.
Grade 2: Moderate tearing of the ligament, causing moderate pain, swelling, and potentially some bruising. A physical assessment may identify some laxity or instability in the joint.
Grade 3: A complete rupture of the ligament. There will be significant pain, swelling, and bruising. Ongoing instability, laxity and a loss of balance will be experienced.
(Bergman, Li & Shuman, 2025; Sports Medicine Australia, 2025; Gaddi et al., 2022)
A trained professional will complete a series of assessments to determine which structures have been damaged. They will utilise guidelines such as the Ottawa Ankle Rules to screen high risk fractures, and rule out other more serious injuries such as sprains to more important ligaments (like the AITFL or deltoid ligaments) (Ruiz et al., 2022). Not all fractures require medical management, and a physiotherapist can help identify which can be managed conservatively, and which require referral to an orthopaedic surgeon.
Following an ankle sprain, there are typically deficits that linger such as reduced balance, reduced strength, reduced proprioception, and laxity, which all contribute to an increased risk of reinjury. Because of this, a physiotherapist will continually reassess the ankle following an injury to ensure any deficits are identified and addressed early.
Following an assessment, your physiotherapist will give you a personalised plan to address any identified deficits to strength, balance and range of motion, and manage pain.
In the case of a simple lateral ankle sprain with no other injuries or fractures, follow RICE guidelines (rest, ice, compress, elevate) for 48-72 hours (Gaddi et al., 2022). During this time, try to keep the ankle moving and it is recommended to return to walking as soon as tolerated (Ruiz-Sanchez et al., 2022; Jungmann et al., 2023). The use of a brace or rigid taping can assist with pain and activity in the early stage (Ruiz-Sanchez et al., 2022).
Deltoid Ligament: In low grade injuries with no laxity or loss of structural integrity, follow RICE protocol for 2-3 days and continue walking and range of motion exercises within comfortable pain levels. In the case of more significant injuries, immobilisation in a CAM Boot may be required for a period of time.
High Ankle Sprain: Involves damage to the AITFL ligament slightly higher up the ankle. Low grade injuries will recover with rest and gentle activity, however a high-grade sprain or full rupture is a significant injury which will require proper management (Liu, Valentine & Ebraheim, 2022). If there is a loss of structural stability to the AITFL and syndesmosis, some time in a CAM Boot is required, and potentially surgery to restore structural integrity to the bones of the lower leg.
Timeframes depend on the severity of the injury, and what structures have been damaged. Returning to sport following a low-grade injury can occur in as short as 2-4 weeks, with higher grade injuries taking as long as a few months (Gaddi et al., 2022).
Chronic ankle instability (CAI) is an umbrella term characterised by ongoing symptoms following an ankle injury, including recurrent sprains, episodes (or the perception of) the ankle “giving way”, persistent pain, swelling, limited range of motion, or weakness of the ankle, ongoing for more than 12 months (Hertel & Corbett, 2019). Approximately 40% of people will experience CAI following a lateral ankle sprain (Hertel & Corbett, 2019).
If you have recently sprained your ankle, are experiencing ongoing symptoms following an ankle sprain, have had multiple sprains, or feel like your ankle is not the same as your unaffected side, a physiotherapist will be able to perform a thorough assessment and provide you with strategies to address ongoing impairments, and protect against future sprains.
References
Bergman, R., Li, D., & Shuman, V. (2025). Acute Ankle Sprain. StatPearls. www.ncbi.nlm.nih.gov/books/NBK459212/
Gaddi. D., Mosca. A., Piatti. M., Munegato. D., Catalano. M., Di Lorenzo. G., Turati. M., Zanchi. N., Piscitelli. D., Chui. K., Zatti. G., & Bigoni. M. (2022). Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Front. Med. 9(868474). doi: 10.3389/fmed.2022.868474
Herbet, J., & Corbett, R. O. (2019). An Updates Model of Chronic Ankle Instability. Journal of Athletic Training, 54(6), DOI: 10.4085/1062-6050-344-18
Jungmann, P. M., Lange, T., Wenning, M., Baumann, F. A., Bamberg, F., & Jung, M. (2023). Ankle Sprains in Athletes: Current Epidemiological, Clinical and Imaging Trends. Open Access Journal of Sports Medicine, 14, 29–46. https://doi.org/10.2147/OAJSM.S397634
Liu, J., Valentine, D., & Ebraheim, N. A. (2022). Management of Syndesmosis Injury: A narrative review. Orthopedic Research and Reviews, 14(1). DOI: 10.2147/ORR.S340533
Ruiz-Sanchez, F., Ruiz-Munoz, M., Martin-Martin, J., Cohena-Jimenez, M., Perez-Belloso, A., Pilar Romero-Galisteo, R., & Gonzalez-Sanchez, M. (2022). Management and treatment of ankle sprains according to clinical practice guidelines: A PRISMA systematic review. Medicine, 101(42). DOI
Sports Medicine Australia. (2025). Ankle Injuries. Sports Injury Fact Sheet. https://sma.org.au/wp-content/2025/10/Ankle-Injury_v1.pdf
