A sprain is defined as a tearing of the ligaments that connect bone to bone and help stabilise the joint. Sports requiring jumping, turning and twisting movements such as basketball, volleyball, netball and football; and explosive changes of direction such as soccer, tennis and hockey are particularly vulnerable to ankle sprains. However people can also sprain their ankles with normal everyday activities such as stepping off a gutter, wearing high heels or walking on uneven ground. Following an ankle sprain, the ankle joint may become unstable and take a long time to recover.

How Ankle Sprains Happen

On the outside of the ankle, the joint is stabilised by three smaller ligaments; the anterior talofibular (at the front), the calcaneofibular (at the side) and the posterior talofibular (at the back). Because these ligaments are much smaller, inversion sprains, where the foot twists inward account for more than 80% of all ankle sprains.

The most commonly injured ligament is the anterior talofibular. Injury to this ligament results in swelling and pain on the outside of the ankle. If the force is more severe, the calcaneofibular ligament is also damaged. The posterior talofibular ligament is less likely to be damaged. A complete tear of all ligaments may result in a dislocation of the ankle joint and an accompanying fracture.

The ligament between the tibia and fibula can also be torn. This is called a high ankle sprain. These injuries may involve a fracture, are often slower to recover, and may require surgery.

Risk Factors for Ankle Sprains

  • Previous or existing ankle injury especially if poorly rehabilitated (biggest risk factor).
  • Lack of strength and stability related to the ankle.
  • Lack of, or extreme flexibility, in the ankle joint.
  • Poor balance.
  • Sudden change in direction (acceleration or deceleration).
  • Increasing age

Treatment of an Ankle Sprain

Immediate Management

The immediate treatment of any soft tissue injury consists of the RICER protocol:




Elevation, and


RICE protocol should be followed for 48–72 hours. The aim is to reduce the bleeding and damage

within the joint. The ankle should be rested in an elevated position with an ice pack applied for 20 minutes every two hours. A correctly sized compression bandage should be applied to limit bleeding and swelling in the joint.

The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.

A Physiotherapist should be seen as soon as possible after the injury to determine the extent of injury and to advise on treatment and rehabilitation. In evaluating the injury the Physiotherapist may order an x-ray or other testing to determine the extent of the injury.

Managing after 48 hours

Most ankle sprains heal within 2 to 6 weeks, however severe sprains many take as long as 12 weeks. Completing a comprehensive rehabilitation program is essential to avoid a re-injury of the ankle (see risk factors).

Your Physio will guide you in your rehab as well as providing taping or a brace to support the ankle while you are regaining function. You can wear the tape for up to 48hours unless you experience any increased ankle pain or skin irritation.

When your Physio says your ankle is ready it is important to try to walk normally – heel to toe. Try not to limp. Prolonged bed rest delays recover, and is not recommended.