Rx3: Ankle Pain FAQs

What is an ankle sprain?

An ankle sprain is an injury to the ligaments of the ankle, most commonly on the lateral (outer) side. Ankle sprains are the most common musculoskeletal injury suffered during physical activity or participation in sports.

Ankle sprains occur when the joint extends beyond its normal range of motion. The ligaments of the ankle connect the ankle bones, including the tibia, fibula, talus, and calcaneus. When these ligaments are stretched or torn, this can result in pain, swelling, bruising, and loss of motion and function of the ankle. Most ankle sprains involve the lateral (outer) ligament complex and are commonly referred to as lateral or inversion (turning inward) ankle sprains. The most common mechanism of injury involves the ankle and foot undergoing loading while in a position of plantarflexion (toes pointed downward) and inversion (turning inward). Ankle sprains are graded on a scale of 1 to 3, with grade 1 being least severe and grade 3 being most severe.

What are the symptoms of ankle sprain?

The symptoms of ankle sprain can include pain, swelling, bruising, tenderness, decreased motion, or instability of the ankle. These increase in severity depending on the grade of the ankle sprain. The following generally apply:

Grade 1 (mild): Minimal pain and disability, with weight-bearing not impaired; mild swelling and tenderness involved, with a slight stretch of the ankle ligaments; no joint instability

Grade 2 (moderate): Moderate pain and disability; weight-bearing might be difficult; moderate tenderness and swelling around the ankle; some instability of the ankle with movement due to complete and partial ligament tears

Grade 3 (severe): Severe pain and disability, with no weight-bearing possible; significant tenderness and swelling around the ankle; obvious instability of the ankle joint due to complete tearing of multiple ligaments

Is there a test for ankle sprains?

Your healthcare provider will ask you about your injury and perform a physical exam. Your provider also might order imaging tests such as X-rays, stress X-rays, ultrasound, or MRI to rule out other injuries or conditions in your ankle or lower leg.

How is an ankle sprain treated?

Initial treatment of ankle sprain usually involves functional treatment—that is, rehabilitation during which the ankle is not completely immobilized—to control inflammation, maintain range of motion, and return to pain-free weight-bearing. However, if your injury involves more than sprained ankle ligaments, such as a bone fracture in your foot or ankle, you might be put in a cast for a period of time initially. Rehabilitation of an ankle sprain should begin early with a program comprised of exercises to increase the range of motion, isometric strength, and proprioception (knowing where your body is, and how it’s moving in space) in your ankle and lower leg, as directed by your provider. Isometric strength exercises require you to push against something without moving through a range of motion, such as resting your foot flat on the floor and pushing down as if you’re stepping on a gas pedal. Proprioception exercises help improve your awareness of where your foot, ankle, and lower leg are relative to each other in space. Focus on using proper form during exercise to help improve proprioception.

The Rx3 ankle sprain program organizes the exercises by phases based on how far along you are in the recovery process. Unless your healthcare provider tells you otherwise, start with Phase 1. Advance to the next phase no sooner than 3 weeks and only when you feel you have mastered the exercises and can perform them with minimal effort and discomfort. If you have pain during or after the Phase 1 exercises, or if you have questions about when to go on to the next phase, check with your healthcare provider.

Each phase includes a session of ankle and lower-leg exercises, core exercises, a cardio component, and stretching. Make sure you always do all the parts of each session in order.

The overall goal of this program is to reduce your ankle pain and increase your overall physical fitness. Your healthcare provider might recommend using these exercises along with another treatment plan.

Grade 1 and 2 ankle sprains are treated with stirrup ankle braces for 6–12 months after injury and, ideally, any time you are participating in activities where you might sprain your ankle again. Ankle braces are not a substitute for exercise-based rehabilitation, but they should be used as part of the full rehabilitation process.

Velcro strap stirrup ankle brace (A), lace-up stirrup ankle brace (B), and pneumatic stirrup ankle brace (C)
Velcro strap stirrup ankle brace (A), lace-up stirrup ankle brace (B), and pneumatic stirrup ankle brace (C)

How long is this ankle rehabilitation program?

Complete the program at least 3 days a week, increasing to 5 days a week as it becomes easier. Each exercise session should take about 20 minutes, plus the cardio component, and less than 15 minutes for stretching. You will need very little equipment for this program. Each phase takes at least 3 weeks, so the program will take you at least 9 weeks total, but the actual time you need to recover will depend on your specific injury condition.

How can I contact HPRC if I have questions?

HPRC has an Ask the Expert feature where you can submit your questions. Patients and healthcare professionals are both welcome. Our experts will reply with detailed information.