Ankle Sprains

Immediate Care, Subsequent Care, & Return to Athletics

Ankle sprains are among the most common sports injuries, accounting for roughly 25% of all sports-related cases. They occur when the strong ligaments that stabilize the ankle are stretched beyond their normal range, resulting in partial or complete damage.

Overview

Proper management during the first 24–48 hours is critical for a safe and efficient return to sport. We follow the PEACE & LOVE approach for acute injury care — prioritizing protection, gentle movement, and long-term healing over outdated ice-heavy methods.

If you notice a visible deformity, seek care at an Urgent Care center or Emergency Department immediately. See our “Where Should You Go?” page for guidance.

Always follow up with your Athletic Trainer as soon as possible after an injury.

Immediate Care

Key PEACE & LOVE Takeaways

No ice — Ice can interfere with inflammation, angiogenesis, and tissue repair, potentially delaying recovery.
Pain relief only with acetaminophen (Tylenol) as needed during the first 24–48 hours.
Avoid Ice & NSAIDs (Advil, Motrin, Ibuprofen, Aleve, Naproxen) for at least 48 hours
- They may slow healing
- Swelling is part of healing
Limit walking — Use crutches or supportive devices if needed.

Hourly Range-of-Motion Exercises

Complete every hour, with the leg elevated above heart level and moving only within a pain-free range.

Subsequent Care

After 24–48 Hours Post-Injury

Continue only if pain-free or working at a tolerable level. If swelling/bruising persists, continue to add the Immediate Care hourly range-of-motion exercises at each stage.

Daily Stretches

4×/Day, 30 seconds each, complete on both sides - Typically, wake-up, before practice, after practice, before sleep

Gastrocnemius Stretch
Medial Gastrocnemius & Flexors — Same stretch, rotate foot in 45°
Lateral Gastrocnemius & Peroneals — Same stretch, rotate foot out 45°
Soleus Stretch

Stage 1 – Early Strengthening

2×/day — If not fully weight-bearing

Seated Calf Raise 2×15 (no weight)
Rotate-In Seated Calf Raise 2×15 (foot in 45°)
Rotate-Out Seated Calf Raise 2×15 (foot out 45°)

Stage 2 – Full Weight-Bearing Strength

2×/day — Pain-free in daily activities

Standing Calf Raise 2×15
Rotate-In Standing Calf Raise 2×15 (foot in 45°)
Rotate-Out Standing Calf Raise 2×15 (foot out 45°)
Bent Knee Standing Calf Raise 2×15
Eccentric Calf Raises 2×30 each leg (1 sec up, 4 sec down, on a stair)

Stage 3 – Single-Leg Strength & Balance

1×/day — Once back in modified practice

Single-Leg Standing Calf Raise 2×15 each
Rotate-In Single-Leg Calf Raise 2×15 (foot in 45°)
Rotate-Out Single-Leg Calf Raise 2×15 (foot out 45°)
Single-Leg Bent Knee Calf Raise 2×15
Single-Leg Balance 2×15 sec

Stage 4 – Intro to Plyometrics & Dynamic Balance

3×/week — Once athlete can perform Stage 3 without pain/swelling
Focus: Controlled hops, light impact tolerance, and dynamic stability.

Double-Leg Line Hops (Front–Back) – 3×20 seconds
- Small, quick hops over a line, focusing on soft landings.
Lateral Step-Overs – 3×10 each side
- Step sideways over a low hurdle/cone, landing softly on both feet.
- Encourages lateral ankle stability.
Single-Leg “Mini” Hops in Place – 3×10 each leg
- Hop no more than 2–3 inches off the ground.
- Land with a slight knee bend to absorb impact.
Heel Raise to Hop – 3×8 each leg
- Perform a slow single-leg calf raise, then hop once and stick the landing.
- Trains calf power under control.
Star Pattern Hops – 3×1 cycle each leg
- Hop in a small star/plus pattern: forward, back to center, side, back to center, other side, back to center.
- Improves multi-directional control.

Stage 5 – Sport Performance & Agility

Single-Leg Hops for Distance – 3×5 each leg

Hop forward as far as possible, stick the landing, reset.
Soft, controlled landings.

Diagonal Bounds – 3×10 each direction

Bound forward and laterally, alternating sides.
Builds calf, ankle, and hip stability.

Agility Ladder Drills – 3 passes each pattern

Patterns: in–in–out–out, single-leg hops, side shuffles.
Stay light and quick on the toes.

Box Jumps (Double- & Single-Leg) – 3×8

Land softly with proper knee and ankle alignment.
Adjust box height for ability/sport.

Return to Athletics

An athlete should return to athletics after an ankle sprain only when functional performance and limb symmetry meet safe return-to-play standards.

Recommended Criteria for Return

A physical examination of the injured joint
Limb symmetry index: ≥90% of the contralateral (opposite) uninjured limb
Hop tests (single, triple, crossover, and side hops): >95% of the uninjured limb’s performance
Agility test results: Within normal ranges for the athlete’s sport and position

These tests must be performed under the supervision of an athletic trainer or qualified healthcare provider to ensure accuracy and safety.

Ankle Taping vs. Ankle Bracing

According to the Journal of Orthopaedic & Sports Physical Therapy (Source: JOSPT: The Role of Ankle Bracing for Prevention of Ankle Sprain Injuries), ankle bracing is more effective than ankle taping for reducing re-injury risk.

Study findings:

Taped ankles: 4.7 sprains per 1,000 exposures (0.47% risk)
Braced ankles: 2.9 sprains per 1,000 exposures (0.29% risk)

What this means: Athletes using ankle braces have a lower chance of re-spraining their ankle compared to those using only tape.

Ankle Brace Recommendation

The gold standard for injury prevention and re-injury protection is a laced ankle brace with strap configurations.

Recommended Models:

Many sports equipment retailers and online stores carry these models. Choose a brace that fits comfortably and provides full ankle coverage without restricting sport-specific movement.

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