Ankle Sprain Treatment and Recovery
Step-by-step ankle sprain treatment guidelines for a complete sprained ankle recovery.
by Brad Walker | First Published January 26, 2004 | Updated July 2, 2019
I say 110% because it’s always my goal to rehabilitate the injured area (in this case my ankle joint), to the point where it’s stronger after the injury, than it was before the injury.
A Perfect Day
Let me paint you a picture. It’s Sunday afternoon in late August. It’s a perfect 80 degrees F (about 26 degrees Celsius), clear sky, light breeze and I’m enjoying the day with family and friends at a local park by the beach.
After feasting on a barbecue lunch and a few cold beers, we decide to kick the soccer ball around to work off all that food. So here I am; no warm-up, no stretching, and running around in bare feet on very un-even ground. I should have known better, and I bet you can guess what happened next.
So the inevitable happens. I step into a hole and go over on my left ankle. Nothing too severe; most likely just some minor stretching of the ligaments. So minor in fact, that I keep playing for another 15 or 20 minutes.
By the time I got home that evening I knew I needed to do something about the ankle. I’d never injured it before and I didn’t want it to turn into one of those nagging, re-occurring injuries, so I thought I would take some of my own advice.
Here’s a tip: Always keep a few ice packs in the freezer. You never know when you’ll need one and applying ice within the first 12 to 24 hours after an injury (preferably within the first 2 to 3 hours if possible), will speed up the healing process and make future rehab and recovery a lot easier.
Sprained Ankle Treatment Begins
- Sunday evening: I start by getting an ice pack out of the freezer, sticking my ankle up on the coffee table and applying the ice pack directly to the injured ankle. I keep the ice on for about 20 minutes and then give it a rest for a while. Over the course of the evening I applied the ice another 2 or 3 times for about 20 minutes at a time.
- Monday morning: The first thing I notice is that my ankle is very stiff and a little sore. It feels tight and difficult to move. I’m not too concerned about it at this point in time. I’ve had my fair share of sprains and strains, and I know this is all part of the healing process. I keep up with the ice, applying it 5 to 6 times throughout the day. I also try to keep off it as much as I can; not wanting to put too much weight on it.
- Tuesday morning: My ankle is still a bit stiff, but most of the soreness has gone. I do my best to stay off it as much as possible and apply ice a couple of times throughout the day.
- Wednesday morning: My ankle feels good; still a little stiff but no swelling or pain. It’s time to move onto a few easy range-of-movement exercises and apply a little weight to the ankle. I start with a few gentle movements; pushing my foot forward and stretching out the ankle; then pulling my toes back towards my shin; and then move onto some gentle circling motion. Later in the day I start to apply normal pressure to my ankle by standing with equal weight on both feet, and by the end of the day I’m walking without favoring my good ankle.
- Thursday morning: My ankle feels fine, …but it’s at this point that most people will make the mistake of thinking that everything is okay and discontinue any further treatment. Just because the injury feels better doesn’t mean it has fully recovered and if you stop treatment now, you’re at risk of continual re-injury until the complete rehabilitation has been successful.
Warning: Never do any activity that hurts the injured area. Of course you may feel some discomfort, but NEVER, NEVER push yourself to the point where you’re feeling pain. Listen to your body and don’t over-do-it at this early stage of the recovery.
How do Ligaments Recover?
To see what’s been going on under the surface, let’s take a quick look at how damaged ligaments repair.
When any sort of damage occurs to the ligaments (remember, ligaments attach bone to bone), the body immediately goes into a process of repair. Where the individual fibers have been ruptured, or torn, the body begins to bind the damaged fibers together using a fibrous protein called collagen. Or as it’s more commonly known; scar tissue.
When a ligament is torn, you would expect the body to repair that tear with new ligament. In reality, this doesn’t happen. The tear, or rupture, is repaired with scar tissue. This may not sound like a big deal, but if you have ever suffered an ankle sprain, (or any soft tissue injury) you’ll know how annoying it is to keep re-injuring that same old injury, over and over again.
When scar tissue forms around an injury site, it is never as strong as the ligament it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.
Recap: Scar tissue is made from a very inflexible fibrous material. This fibrous material binds itself to the damaged ligaments in an effort to draw the damaged fibers back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it’s even possible to see and feel this bulky mass under the skin.
How to get rid of scar tissue
Heat and Massage: Throughout the day I used a hot water bottle to apply heat to the injured area, which helps by stimulating blood flow. I also started to use light massage on the ankle and specifically at the injury site. Massage is a very important process that helps to breakdown, remove and re-align the scar tissue. Without massage very few sports injuries will heal completely.
Active Rehabilitation and Recovery
- Friday morning: My ankle feels great, so it’s time to get into some serious rehabilitation. I start off with some easy mobility exercises and then follow them up with a good massage. I start with light strokes and gradually increase the pressure until I’m using firm, deep strokes. I concentrate all the pressure at the direct point of injury, and use my thumbs to get in as deep as possible to break down the scar tissue. After a 10 minute massage, I continue with a few more mobility exercises, but this time I push them a little bit further and a little bit harder. I then finish off with some very gentle stretching exercises. Later that evening I give my ankle another massage while sitting in front of the TV, and finish with some more stretches.
- Saturday to Monday: Over the course of the next few days I massage my ankle another 2 or 3 times and keep some heat on it whenever I’m at home. I constantly stretch my ankle and do my range-of-movement exercises, and I gradually incorporate some weight bearing exercises like balancing on one leg, half squats and half lunges.
- The following week: My ankle feels great. I went for an easy walk on Monday morning and included a few stretches for my ankle and lower legs. Throughout the week I continued with my range-of-movement and balancing exercises, and towards the end of the week I started on some very easy plyometric exercises. These are explosive type exercises and include things like jumping, hoping, skipping and bounding.
- Over the next month: I continued with all the exercises I’ve listed above, gave my ankle the occasional massage and kept up with the stretching. I also included a series of more intense exercises to help really strengthen my ankles and lower legs. Exercises like single leg plyometric drills, weight training exercises like squats, lunges, leg press and various forms of calf raises, plus started to run again.
Today, my ankle feels strong and stable, and I know it’s in better shape now, than it was before the injury.
Ankle Sprain Prevention
So now that your sprained ankle is fully recovered, what are some of the other things you can do to help prevent an ankle sprain in the future?
- Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity.
- Plyometric Training: Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments at the ankle joint.
- Balancing Exercises: Any activity that challenges your ability to balance, and keep your balance, will help what’s called proprioception: – your body’s ability to know where it’s limbs are at any given time.
- Footwear: Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankle stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion.
- Strapping: Strapping, or taping can provide an added level of support and stability to weak or injured ankles. For a detailed description of how to strap an ankle properly, watch the short 2 minute video below.
- Stretching: Improving flexibility allows the ankle joint to go through a larger range of motion without incurring injuries. It also improves the ability of the muscles to contract and protect in those extended ranges. Below are 2 simple stretches to help prevent a sprained ankle.
Leaning Heel-Back Calf Stretch (1:19) Stand upright and lean against a wall. Place one foot as far from the wall as is comfortable and make sure that both toes are facing forward and your heel is on the ground. Keep your back leg straight and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Leaning Heel-Back Achilles Stretch (1:17) Stand upright while leaning against a wall and place one foot behind the other. Make sure that both toes are facing forward and your heel is on the ground. Bend your back leg and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Regulate the intensity of this stretch by lowering your body. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
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Research and References
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Porter, D. Schon, L. (2008). Baxter’s The Foot and Ankle in Sport, 2nd Edition (ISBN: 978-0323023580)
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Wikipedia contributors. (2019, June 17). Sprained ankle, In Wikipedia, The Free Encyclopedia.
- Vuurberg, G. Hoorntje, A. Wink, L. van der Doelen, B. van den Bekerom, M. Dekker, R., van Dijk, C. Krips, R. Loogman, M. Ridderikhof, M. Smithuis, F. Stufkens, S. Verhagen, E. de Bie, R. Kerkhoffs, G. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine, 52(15):956.
- Hubbard, T. Wikstrom, E. (2010). Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access Journal of Sports Medicine, 1: 115–122.
- Lin, C. Hiller, C. de Bie, R. (2010). Evidence-based treatment for ankle injuries: a clinical perspective. Journal of Manual and Manipulative Therapy, 18(1): 22–28.
- Verhagen, E. van Mechelen, W. de Vente, W. (2004). The effect of preventive measures on the incidence of ankle sprains. Clinical Journal of Sport Medicine, 10(4), 291-296.
- Stasinopoulos, D. (2004). Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players. British Journal of Sports Medicine, 38(2), 182-185.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.