How to treat an ankle sprain
11.11.19|Posted by Afsaneh Abedi

How to manage a sprained ankle with physiotherapy

Afsaneh Abedi is an Ascenti Physiotherapist based in the East Midlands. Having worked in a hospital setting and with a keen interest in musculoskeletal (MSK) physiotherapy, Afsaneh has seen many ankle injuries. Here is her expert advice about ankle sprains and how to manage them.

An ankle sprain is one of the most common musculoskeletal (MSK) injuries that physiotherapists see.

The predisposition of your ankle means that you can easily twist or put too much force on the area which can lead to damage. For example, when playing sports or if you accidently fall. 

What is a sprained ankle?

Your ankle joints are made up of bones that connect your feet to the bottom of your legs. 

These joints are supported and surrounded by a range of what we call soft-tissues, including muscles, tendons and ligaments. 

When you sprain your ankle you damage or tear some of these soft-tissues.

What are the symptoms of an ankle sprain?

The immediate pain and swelling can be worrying, but it’s important to remember that the majority of sprained ankles will heal and recover well with the correct treatment. 

The swelling is a natural part of the inflammation process and is your body’s way of protecting the injury site.  

Because your ankle is part of your lower body the fluid also collects, so it can swell a lot within the first 48 hours. 

How long does it take to recover from a sprained ankle?

We use a grading system from 1 -3 to diagnose the severity of ankle sprains.

You should be reassured that most ankle sprains are grade 1 or 2. 

Grade 1 ankle sprain

Used to describe a mild ankle sprain, strain or tear.  Your ankle injury will present with swelling and tenderness, but should heal within 2-3 weeks with the right care. 

Grade 2 ankle sprain

More extensive damage and with more soft-tissue involved. Your ankle injury can take between 4-8 weeks to recover fully and you will benefit from physiotherapy to help get you back on track. 

Grade 3 ankle sprain

Used to describe a serious or complete rupture or tear of the ankle, sometimes accompanied by a bone break. If you had a grade 3 ankle sprain you would require and be seeking urgent medical attention, for example by calling the NHS helpline on 111 or visiting A&E. Recovery timeframes will vary depending on what management is deemed most appropriate. 

What should I do within the first 1-3 days?

During the first 3 days of an ankle sprain, your body enters what we call the ‘inflammatory stage’. This stage is often the most painful and needs the correct management, known as PEACE: 

P Protection - avoid activities and movements that increase pain for the first few days.
E Elevation - elevate the injured limb higher than the heart as often as possible.
A Avoid taking anti-inflammatory medication as they can reduce tissue healing. Avoid icing for more than 5 minutes.
C Compression - use a compression bandage or taping to reduce swelling.
E Education - your body knows best. Avoid unnecessary treatments and medical investigations and let nature play its role.

What else should I avoid?

During the first 3 days after injury you should remember the ‘NO HARM’ protocol. This means no:

  • Heat 
  • Alcohol 
  • Running / exercise 
  • Massage 

These activities may prevent or slow down the healing process. 

What should I do after the first 3 days?

After this time, and for the next 7-14 days the injury needs LOVE:

L Load - let pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load.

O Optimism - condition your brain for optimal recovery by being confident and positive

V Vascularisation - choose pain free cardio-vascular/aerobic activities to increase blood flow to repairing tissues

E Exercise - restore mobility, strength and balance by adopting an active approach to recovery.

Here’s some more information about some of these stages:


Avoid any activities that increase pain and protect the area from further damage. However complete rest should be minimised as this can also delay repair.

Move your injured part little and often into directions that do not cause sharp pain when you are sitting down or when there is no weight going through the area. Do not move into any positions that caused the injury in the first instance. For example, if you twisted your knee, don’t twist it into the same direction or position again.

The use of a brace or splint may be helpful depending on the severity of the injury.


Keep the affected area supported and higher than the joint above it. 

For example, if the injured area is your ankle then sit with your leg out straight supported on a pillow to raise it higher than your knee. This will prevent excessive swelling. 

This should be done as much as possible in the first 3 days if swelling is a problem.

Avoid anti-inflammatories and icing for long periods

Icing the area can help with any pain relief, but it may also interfere with healing tissues if applied for long periods. If you’d like to use ice for pain relief, follow the steps below during the first 3 days, after this time you can use ice for up to 20 minutes. 

  • Rub some barrier oil or moisturiser on the area you are going to ice. This can be olive oil, vegetable oil, almond oil or whatever you have. This helps to avoid any sticking. 
  • Wrap crushed ice, frozen peas or a chill pack from the freezer in a clean and damp tea-towel.
  • Place over the area and secure with another towel.
  • Never place your calf or thigh on top of the ice, always place ice on the body part as the extra compression can increase the risk of an ice burn.
  • Leave for 5 mins and remove if it gets painfully cold (after 3 days this can be left for up to 20 minutes).
  • Repeat every 2 hours for acute or severe injuries or 3-4 times a day for less serious injuries or complaints. 
  • The skin will look pink when you remove the ice but this is normal.

Do not apply ice if you have any loss of sensation or numbness in the area, extreme sensitivity to cold, poor circulation in your hands or feet, Raynaud’s disease or broken skin.


Some people find a compression bandage or support helpful in the early stages of a soft-tissue injury. This is optional, not essential, and should not be used if you are also elevating the area.

Then after 3 days…


This is a technical way of saying keep the ankle moving as much as you are able to and within your comfort zone. You can still do this with the use of a brace or splint to support your ankle. 

During this period, your ankle will still feel quite sore, weak, swollen and difficult to move.

This is the time when small, controlled movements can really help the healing tissues form in the right direction and pattern to ensure the newly healed area becomes flexible and strong like the original tissue was. 

Frequent movements in all of the directions that the area will move into will help. This should not be against any weight or pressure, just gentle repeated movements every few hours

The next stage should be to start applying weight to the ankle again. 

Try moving more and stop using any crutches at this point so that you can regain normal function in the legs and work towards walking normally again. 

These stability exercises can also help you to fully restore the strength in your ankle.

The most important thing is to listen to your body and to not push yourself too hard. 

When should I see a physiotherapist or seek extra help?

If you feel that you are struggling to fully recover from an ankle sprain after 3 weeks then you should see a physiotherapist. 

Don’t suffer and return to your normal activities or playing sports if it hasn’t fully healed. 

This can prolong your recovery and increase your chances of future sprains. 

How can physiotherapy help my ankle sprain?

Many ankle sprains will heal well on their own and with the right care, but physiotherapy can help to identify any causes for a delayed recovery, such as stability issues. 

Your physiotherapist will work with you to diagnose the injury and develop a treatment plan which may include manual therapies, such as joint mobilisation and soft-tissue massage. 

These therapies can help to remove scar tissue, reduce stiffness and restore full movement to the ankle, which can accelerate healing. 

They will also work with you to look at your biomechanics and how your body distributes weight down your legs and ankle. 

Your physiotherapist will give you exercises to complete at home to improve strength and stability. These will be an important part of your long term recovery from a sprained ankle. 

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