You stepped off a kerb the wrong way, rolled your ankle on a netball court, or landed awkwardly from a run. There was a sharp pain, the ankle swelled within an hour, and now you are wondering whether it is something you can ride out or something that needs a clinician. A sprained ankle is one of the most common musculoskeletal injuries we see, and how you handle the first 72 hours matters.
01 . What it is
What a sprained ankle actually is
A sprained ankle is an injury to one or more of the ligaments that hold the ankle bones in place. Ligaments are tough, fibrous bands of tissue. When the ankle is forced past its normal range, those ligaments stretch and sometimes tear. The injury usually happens in a fraction of a second: the foot rolls, the body keeps moving, and the ankle takes the load it was not built to handle.
There are three main patterns we see in clinic:
- Lateral (outside) sprains are by far the most common. The foot rolls inward and the ligaments on the outside of the ankle (most often the anterior talofibular ligament) take the strain. The large majority of ankle sprains are this type.
- Medial (inside) sprains happen when the foot rolls outward. The ligaments on the inside of the ankle (the deltoid ligament group) are stronger than the outer ones, which is part of why these sprains are less common.
- High ankle sprains (syndesmosis injuries) affect the ligaments that hold the two lower leg bones together, just above the ankle joint. These often follow a twisting injury during sport and usually need a longer rehab than a standard lateral sprain.
The signs are familiar: pain at the moment of injury, swelling that comes on within the first hour, bruising over the next day or two, difficulty bearing weight, and a sense that the ankle is unstable or unreliable. None of these on their own tells you the severity, which is part of why a clinical assessment is the right next step if the injury is more than mild.
02 . The first 72 hours
What to do in the first 72 hours: POLICE
For decades the standard first-aid advice was RICE (Rest, Ice, Compression, Elevation). The current international consensus has updated that to POLICE: Protection, Optimal Loading, Ice, Compression, Elevation. The change matters because the evidence now shows that prolonged rest delays healing rather than helping it.
Protection. Settle the ankle. Avoid the movements that caused the injury and anything that flares the pain in the first day or two. A short period of crutches or a brace is appropriate if walking is sharply painful, but full bed rest is not.
Optimal Loading. This is the key change from the old RICE rule. Gentle, pain-guided movement from early on sends the right signals for healing: small ankle circles, weight-shifting drills, short walks within tolerance. Pure rest weakens muscle, stiffens the joint, and lengthens the recovery.
Ice. Apply a wrapped ice pack to the swollen area for 15-20 minutes at a time, every two to three hours through the first 48 hours. Do not put ice directly on skin.
Compression. A firm but not tight compression bandage (or a sleeve) over the ankle and lower calf helps control swelling. Keep it on during waking hours through the first 48-72 hours and take it off overnight.
Elevation. When you are sitting or lying down, prop the ankle above the level of your heart. This uses gravity to help drain the swelling.
A note on anti-inflammatory medications: current guidelines suggest using non-steroidal anti-inflammatory drugs cautiously after an ankle sprain. They can ease pain and swelling in the short term but may interfere with the natural healing process if used heavily or for long periods. Talk to your GP or pharmacist before relying on them.
Optimal Loading is the key change from the old RICE rule. Gentle, pain-guided movement from early on sends the right signals for healing.
03 . When to see a clinician
When to see a Physiotherapist or Podiatrist
Most mild ankle sprains respond well to POLICE and settle over the following days to weeks. Even so, three patterns are worth booking an assessment for.
The Ottawa Ankle Rules. Clinicians around the world use a short checklist to decide when an X-ray is warranted after an acute ankle injury. An X-ray is recommended if any of the following are true:
- You cannot bear weight for four steps, either at the time of injury or in the emergency department.
- There is bony tenderness along the back edge or tip of either ankle bone (the malleoli).
- There is bony tenderness over the base of the fifth metatarsal (the bony bump on the outside of your midfoot) or over the navicular (the inside of your midfoot).
If any of those apply, get to a GP or emergency department for imaging before assuming the injury is a sprain.
Symptoms are not settling. If the ankle is still significantly swollen, painful or weak after seven to ten days of POLICE, or if you cannot walk without limping after two weeks, book an assessment. A Physiotherapist or Podiatrist can rule out the things that mimic a simple sprain (a hairline fracture, a high ankle sprain, a tendon injury) and start a structured rehab plan.
The ankle is giving way. If the ankle has started to “go” on uneven ground or you have had more than one sprain in the same ankle, you may be developing chronic ankle instability. This is a pattern of ongoing weakness and proprioceptive (balance) loss that responds well to structured rehab but rarely settles on its own.
For an overview of related conditions that can show up after a sprain, see our guide to anterior ankle impingement. For broader muscle and soft-tissue injury management, see have you strained a muscle.
04 . Rehab and return
Rehab and return to activity
Once the acute swelling has settled, the work shifts from protecting the joint to rebuilding it. The international guideline favours supervised, exercise-based rehabilitation over passive treatments or rest alone, because guided movement is what rebuilds stable, reliable control of the joint.
A typical rehab plan progresses through four overlapping stages.
- Range of motion. Gentle ankle circles, calf stretches and dorsiflexion drills (knee-over-toe lunges with the heel down) bring the joint back to its normal movement range.
- Strength. Heel raises, toe raises, and resisted band work for all four directions of ankle movement (in, out, up, down) rebuild the muscles that protect the joint.
- Balance and proprioception. Single-leg standing, wobble-board and unstable-surface drills retrain the small reflexes that catch the ankle before it rolls. This is one of the most important parts of lowering re-injury risk.
- Graded return to activity. Walking progresses to jogging, then to running and changes of direction, then back to sport-specific drills. The timeline is pain- and confidence-guided, not date-based.
A Physiotherapist or Podiatrist can build a graded return-to-activity plan with you, set the criteria for progressing each stage, and adjust the program based on how the ankle responds. For some patients, a biomechanical assessment of foot posture and gait identifies factors that are loading the ankle unevenly. In a small number of cases, a custom orthotic or external support is part of the plan. Orthotics are one tool among several, not a default prescription. They are considered after the assessment, not before.
05 . Preventing the next one
How to lower the risk of another sprain
Once you have sprained an ankle, the next one is more likely. Ankle sprains carry a high rate of recurrence, often because the first injury was never fully rehabbed. The good news is that targeted prevention work measurably lowers that risk.
Three things make the biggest difference.
- Finish the rehab. Going back to sport when the swelling has gone but the strength and balance work has not been done is the single most common reason for repeat sprains. A structured program through to full return-to-sport criteria is the foundation.
- Use a brace or taping for higher-risk activities. After a moderate or severe sprain, a lace-up brace or supportive taping during sport reduces re-injury risk, especially in the months while strength and balance are still rebuilding. This is well-supported by the international guideline.
- Train the balance system. Ongoing single-leg balance and proprioceptive work, even a few minutes a few times a week, keeps the protective reflexes sharp. This is the part most people drop once the injury has settled, and it is the part that matters most for the next twelve months.
Footwear, training load, ankle mobility and surrounding strength (hip and glute control) all matter too. A Physiotherapist or Podiatrist can assess your specific risk factors and prioritise the work that will give you the biggest return for the time you put in.
Further reading
- Physiotherapy: what a Physiotherapy assessment looks like at Optimum Health Solutions.
- Podiatry: foot, gait and orthotic assessment for ankle and lower-limb problems.
- Anterior ankle impingement: a common post-sprain condition where the front of the ankle stays painful long after the swelling has gone.
- Have you strained a muscle?: the companion guide on soft-tissue strain management.
- Our team: meet the clinicians who review our musculoskeletal content.
