Ankle Sprains
Immediate Care, Subsequent Care, & Return to Athletics
Immediate Care, Subsequent Care, & Return to Athletics
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the PEACE & LOVE approach for acute injury care — prioritizing protection, gentle movement, and long-term healing over outdated ice-heavy methods.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.
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.
Complete every hour, with the leg elevated above heart level and moving only within a pain-free range.
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.
4×/Day, 30 seconds each, complete on both sides - Typically, wake-up, before practice, after practice, before sleep
Medial Gastrocnemius & Flexors — Same stretch, rotate foot in 45°
Lateral Gastrocnemius & Peroneals — Same stretch, rotate foot out 45°
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°)
2×/day — Pain-free in daily activities
Rotate-In Standing Calf Raise 2×15 (foot in 45°)
Rotate-Out Standing Calf Raise 2×15 (foot out 45°)
Eccentric Calf Raises 2×30 each leg (1 sec up, 4 sec down, on a stair)
1×/day — Once back in modified practice
Rotate-In Single-Leg Calf Raise 2×15 (foot in 45°)
Rotate-Out Single-Leg Calf Raise 2×15 (foot out 45°)
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.
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.
An athlete should return to athletics after an ankle sprain only when functional performance and limb symmetry meet safe return-to-play standards.
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.
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.
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.