From a Physiotherapist’s Perspective: Understanding Ankle Sprains (and Why You Shouldn’t “Walk It Off”). By Megan Schneider Senior APA Physiotherapist

Ankle sprains are one of the most common injuries we see in clinical practice—and they’re also one of the most underestimated. Whether it happens during a sports match, a hike, or simply stepping awkwardly off a curb, a sprained ankle can range from mildly inconvenient to seriously debilitating.

As physiotherapists, our goal is to not only treat ankle sprains but also to shift the common mindset around them. So let’s talk about what’s really going on when you “roll your ankle” and why proper rehab is crucial for long-term recovery and injury prevention.

 

What Actually Happens During an Ankle Sprain?

Most ankle sprains involve the lateral (outer) ligaments—specifically the anterior talofibular ligament (ATFL). These ligaments act like seatbelts for your ankle, stabilising the joint and preventing it from moving too far in any one direction. When you sprain your ankle, you’re overstretching (and sometimes tearing) those ligaments (Doherty et al., 2017).

Sprains are categorised into three grades:

                  •               Grade I: Mild stretching, microscopic tears—minimal swelling and pain.

                  •               Grade II: Partial ligament tearing—moderate swelling, bruising, instability.

                  •               Grade III: Complete tear—significant swelling, bruising, and joint instability (van Rijn et al., 2008).

 

“It Doesn’t Hurt That Much—Do I Really Need Rehab?”

Yes, you do.

One of the most common mistakes we see is people brushing off a sprain because the pain settles in a few days. But without proper rehabilitation, the ligaments may not fully heal, and the ankle can remain weak and unstable. This sets the stage for repeated sprains, chronic instability, and in some cases, early-onset arthritis (Gribble et al., 2016).

The Physiotherapy Approach: More Than Just Ice and Rest

Here’s what a comprehensive physiotherapy plan typically includes:

                  1.             Initial Management (0–72 hours):

                                    •               RICE: Rest, Ice, Compression, Elevation

                                    •               Gentle range-of-motion exercises (Bleakley et al., 2012)

                  2.             Early Rehab (Week 1–2):

                                    •               Controlled weight-bearing

                                    •               Swelling management

                                    •               Basic balance and proprioception exercises

                  3.             Strengthening and Stability (Weeks 3–6):

                                    •               Targeted strength exercises

                                    •               Neuromuscular retraining

                                    •               Gradual return to sport or activity (Hertel & Corbett, 2019)

                  4.             Injury Prevention:

                                    •               Ongoing mobility and strength work

                                    •               Education on bracing, taping, and footwear (Thacker et al., 1999)

 

Long-Term Impacts if You Don’t Rehab Properly

Failing to properly rehabilitate an ankle sprain can lead to:

                  •               Chronic ankle instability (CAI)

                  •               Reduced performance in sports and daily activity

                  •               Persistent pain and swelling

                  •               Higher risk of re-injury (Gribble et al., 2016)

 

Takeaway: Respect the Sprain

Your body is incredibly adaptive—but only when you give it the right tools and time. If you’ve sprained your ankle, don’t just walk it off. Get assessed, take rehab seriously, and trust the process. Your future ankles will thank you.

 

References

Bleakley, C. M., Glasgow, P., & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine, 46(4), 220–221. https://doi.org/10.1136/bjsports-2011-090297

 

Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 51(2), 113–125. https://doi.org/10.1136/bjsports-2016-096178

 

Gribble, P. A., Bleakley, C. M., Caulfield, B. M., Docherty, C. L., Fourchet, F., Fong, D. T., … & Wikstrom, E. A. (2016). 2016 consensus statement of the International Ankle Consortium: rehabilitation of lateral ankle sprains. British Journal of Sports Medicine, 50(24), 150–175. https://doi.org/10.1136/bjsports-2016-096189

 

Hertel, J., & Corbett, R. O. (2019). An updated model of chronic ankle instability. Journal of Athletic Training, 54(6), 572–588. https://doi.org/10.4085/1062-6050-344-17

 

Thacker, S. B., Stroup, D. F., Branche, C. M., Gilchrist, J., Goodman, R. A., & Weitman, E. A. (1999). The prevention of ankle sprains in sports: a systematic review of the literature. American Journal of Sports Medicine, 27(6), 753–760. https://doi.org/10.1177/03635465990270061301

 

van Rijn, R. M., van Os, A. G., Bernsen, R. M. D., Luijsterburg, P. A. J., Koes, B. W., & Bierma-Zeinstra, S. M. A. (2008). What is the clinical course of acute ankle sprains? A systematic literature review. American Journal of Medicine, 121(4), 324–331. https://doi.org/10.1016/j.amjmed.2007.11.018

Stuart McKayComment