Ankle sprain: first aid, rehabilitation and return to activity

The ankle has ligaments that keep the joint stable. In an ankle sprain, the ligaments on the outside are stretched or injured, most often when the foot rolls inwards after a misstep. This accounts for more than 85 percent of ankle injuries [1]. The anterior ligament is the one most often injured [1].

The Danish Lægehåndbogen distinguishes three grades. Grade 1 is a mild overstretch without instability, grade 2 is a partial tear with mild instability, and grade 3 is a complete tear with instability [2].

Teenagers and young adults are most affected, and the injury is common in sports such as football, basketball and volleyball [1]. In older people a fracture is more often behind the injury [1].

Typically there is swelling in front of and below the outer ankle bone. In a ligament injury it is usually the ligament that is tender, while the ankle bone itself is relatively little tender [1][2].

For the first 48 hours, NHI describes first aid as RICE. This means rest and offloading, cooling, compression with an elastic bandage, and keeping the foot above heart level. Non-elastic tape is not advised in the acute phase [1]. Cooling is described as 20 minutes every three to four hours, and Lægehåndbogen recommends it for the first 24 hours but points out that the effect is debated [1][2].

Crutches can be used for the first two days [1][2]. After that, the joint can be used within what the pain allows [2].

The most important question is whether it is a ligament injury or a fracture [1]. The doctor or therapist feels the bony structures and ligaments. Stress tests have little value right after the injury [1][2].

The Ottawa ankle rules are used to assess whether an x-ray is necessary [2][3]. For the ankle, they concern pain near the ankle bones together with tenderness over the bone or inability to bear weight on the foot. The rules have almost 100 percent sensitivity but low specificity, which means that many are x-rayed without a fracture being present [2].

A new examination a few days after the injury can give a more accurate picture. Husted recommends a clinical examination about five days after the injury [3].

From two to three days after the injury, early movement training is described, often twice a day, with light movements and stretches. Cycling is a gentle start, and weight bearing without crutches is allowed. Tape or an ankle brace can be used during exercise [1][2].

Balance training is described from one to three weeks after the injury, for example on a balance board. The recommended amount is 10 minutes, five times a week, for 10 weeks [1][2]. The exercises are made gradually harder, for example with eyes closed or on an unstable surface [1].

Walking and jogging follow, then changes of direction and sport-specific exercises [1][2]. Husted writes that proprioceptive training and mechanical support can be used both to treat and to prevent ankle injuries [3]. Therapeutic ultrasound is not recommended [2].

Full pain-free movement is often reached within a few weeks [1][2]. Lægehåndbogen states that about 90 percent are pain-free in normal walking one month after the sprain [2].

Joint position sense can take up to 10 weeks to return, and the ligament may need up to six months to heal [1][2]. Because joint position sense is reduced for a period, the ankle can be more prone to a new injury. The risk of a new injury is considerable in the first 12 months [1][2].

The sources give no exact date for returning to sport. They describe a gradual progression from walking to changes of direction and sport-specific exercises [1][2]. Tape or a brace can give some protection during the vulnerable period and is recommended for 6 to 12 months after an acute injury, depending on its extent [1][2].

Contact a doctor if you cannot take more than four steps on the foot, if the ankle bone is strikingly tender, or if there is major swelling and bruising. A fracture may then have to be ruled out with an x-ray [1][2].

If it takes several weeks before you get better, you should be examined again [1]. Lægehåndbogen mentions that persistent pain can indicate cartilage damage, and that the x-ray should be repeated after one month if it still hurts in ordinary walking. If you are not free of symptoms after three months, a new assessment is recommended [2].

Some develop instability in the ankle and feel that it gives way. Surgery is rarely necessary [1][3]. For long-lasting problems, the doctor can consider further investigation or referral to a specialist [1][2].

If a fracture has been ruled out, a physiotherapist can examine the ankle and make a plan with you for exercise and gradually increased loading. It can also be relevant if the ankle feels unstable or has been injured several times. See the page about ankle sprains and physiotherapy at Dr.Dropin.

What is the difference between an ankle roll and an ankle sprain?

Both words describe the same injury: a stretch or tear of the ligaments in the ankle, most often on the outside after the foot rolls inwards [1][2].

What should I do right after rolling my ankle?

NHI describes rest and offloading, cooling for 20 minutes at a time, elastic compression and keeping the foot elevated for the first 48 hours [1]. If you are unsure whether the ankle is broken, you should have it examined [1][2].

How do I know if the ankle is broken?

It cannot be determined with certainty without an examination. Marked tenderness over an ankle bone and inability to take more than four steps raise suspicion of a fracture, and an x-ray is then relevant [1][2].

How long does a sprained ankle take to heal?

Pain-free movement often returns after a few weeks, and about 90 percent are pain-free in normal walking after one month [1][2]. Joint position sense can take up to 10 weeks, and the ligament up to six months [1][2].

Should I rest completely or move the ankle?

Both sources describe rest for the first two days, followed by early movement within what the pain allows. Early movement training is described as beneficial for healing [1][2].

On the page about ankle sprains you will find a short description of the condition and what we can help with. More articles are available in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Ankelskade, overtråkk (Ankle injury, sprain). NHI.no. Last updated 4 February 2025. Based on Legehandboka. Link

2. Kold S, Larsen EP. Ankelskade, akut (Acute ankle injury). Lægehåndbogen, sundhed.dk. Professionally updated 10 June 2025. Link

3. Husted RS. Diagnostik, forebyggelse og behandling af akut lateral ankeldistorsion (Diagnosis, prevention and treatment of acute lateral ankle sprain). Ugeskr Læger. 2019;181(4). Abstract. Link