Ankle sprains are common injuries that occur when the foot twists or turns beyond its normal range of movement, causing the ligaments of the ankle to overstretch or tear. It is estimated that 23,000 Americans experience ankle sprains daily. Of all sports injuries in the United States, 45% are ankle sprains; basketball players are the athletes most often affected. People who have an increased risk of spraining an ankle include younger athletes, members of the military, and anyone who frequently runs, jumps, and changes direction quickly, while performing an athletic activity (“cutting motion”). Physical therapists help people who have experienced ankle sprains reduce their pain; regain their strength, motion, and balance; return to normal activity levels; and avoid reinjury.
Sprains are injuries to ligaments (the bands of tissue that hold joints together). Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments connecting the bones of the leg, ankle, and foot to overstretch or tear.
The ligaments on the outer (lateral) side of the ankle are the ones most commonly injured. Ligaments on the inner (medial) side of the ankle, or above the ankle bone, can also be sprained, but are injured less frequently.
An ankle sprain usually takes between 2 weeks to 2 months to heal. The ankle will feel better after a few weeks, and be fully strengthened in a few months. A severely sprained ligament, however, can take 9 months to 1 year to heal.
Recurrent ankle sprains are common; once an ankle ligament is sprained, it is often reinjured. In fact, 73% of people who have sprained an ankle once are likely to do so again. Reinjury is especially likely if muscle strength and balance are not fully restored to, or improved beyond, preinjury levels.
Right after an ankle sprain, you may experience:
After most sprains, you feel pain right away at the site of the ligament stretch or tear. Often, the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch, and when you move the ankle, it hurts. In more severe sprains, you may hear or feel something tear, along with a “pop” or “snap.”
If you see your physical therapist first, the physical therapist will examine your ankle, take your health history, and ask questions such as:
Your physical therapist will gently press around your ankle to see if it is painful to the touch, and may use additional tests to determine if other parts of your foot are injured. Your physical therapist will test your strength and flexibility, observe how you can move your foot and leg, and watch how you walk.
Depending on how badly a ligament is damaged, or how many ligaments are injured, your ankle sprain may be classified as:
Your physical therapist also will test and screen for other, more serious conditions that could be causing the pain and swelling. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray, to confirm the diagnosis and to rule out other damage to the ankle, including a fracture.
Physical therapists help people with ankle sprains recover more quickly than they would without treatment. The time it takes to heal an ankle sprain varies, but results can often be achieved in 2 to 8 weeks. Your physical therapist will work with you to design a specific treatment program that meets your needs and goals.
During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:
These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing.
Your physical therapist will work with you to:
Reduce Pain and Swelling. You will learn how to avoid or modify your daily and sports activities to allow healing to begin. Your physical therapist may use different types of treatments and technologies to control and reduce your pain and swelling, including ice, heat, ultrasound, electrical stimulation, taping, specific exercises, and hands-on therapy, such as specialized massage.
Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the ankle. These might begin with “passive” motions that the physical therapist performs for you to gently move your ankle and foot, and progress to “active” exercises and stretches that you do yourself.
Improve Flexibility. Your physical therapist will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.
Improve Strength. Ankle sprains may be related to weak, injured, or uncoordinated leg muscles. Certain exercises will aid healing at each stage of recovery; your physical therapist will choose and teach you the correct exercises and equipment to use, to steadily and safely restore your strength. These may include using cuff weights, stretch bands, and weight-lifting equipment.
Improve Endurance. Regaining your muscular endurance in the ankle and leg is important after an injury. Your physical therapist will teach you exercises to improve endurance, so you can return to your normal activities. Cardio-exercise equipment may be used, such as treadmills or stationary bicycles.
Improve Balance. Regaining your sense of balance is important after an injury. Your physical therapist will teach you exercises to improve your balance ability.
Restore Agility. Speed and accuracy of leg movement is important in athletics and in many daily activities. Your physical therapist will help you regain these skills in preparation for a return to sports and to your daily routine.
Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.
Return to Activities. Your physical therapist will discuss activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.
Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
If Surgery Is Necessary
Surgery is not commonly required for ankle sprains. But if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.
Your physical therapist can recommend a home-exercise program to help prevent ankle sprains. It may include strength, flexibility, and balance exercises. If you have sprained your ankle once, it is at greater risk for reinjury in the future, if the ligaments did not heal properly or if your ankle never returned to its normal strength. And if you return to sports or other activities too soon after injury, your ankle might give you persistent pain or might easily or frequently reinjure.
Possible other factors that may increase someone’s risk of spraining an ankle are body weight, female gender, muscle weakness, balance problems, or foot/ankle problems.
To help prevent an ankle sprain or a reinjury, your physical therapist may recommend that you: