10/07/2026
Acute Ankle Sprain: Physiotherapy Management
Acute ankle sprains, most commonly involving the lateral ligament complex (especially the anterior talofibular ligament), are usually managed conservatively with early rehabilitation.
Goals of Physiotherapy
Reduce pain and swelling
Protect injured ligaments
Restore ankle range of motion (ROM)
Improve strength and balance
Return the patient safely to daily activities and sports
Prevent recurrent sprains and chronic ankle instability
Phase 1: Acute Phase (0–3 Days)
Objectives:
Control pain and inflammation
Protect the injured ankle
Management (PEACE approach):
Protection: Avoid activities that increase pain for 1–3 days.
Elevation: Raise the ankle above heart level when possible.
Avoid anti-inflammatory measures if following the PEACE & LOVE framework (some clinicians still use ice for pain relief).
Compression: Elastic bandage or ankle brace to reduce swelling.
Education: Encourage optimal loading and realistic recovery expectations.
Physiotherapy Interventions:
Gentle active toe and ankle movements within pain limits
Protected weight-bearing with crutches if needed
Pain-relieving modalities (if indicated)
Phase 2: Early Rehabilitation (3 Days–2 Weeks)
Objectives:
Restore ROM
Begin strengthening
Improve gait
Exercises:
Active ROM:
Ankle pumps
Alphabet exercises
Dorsiflexion and plantarflexion
Gentle calf stretching
Isometric strengthening
Progress to resisted exercises with resistance bands
Gait training
Continue compression if swelling persists
Phase 3: Strengthening & Proprioception (2–6 Weeks)
Objectives:
Increase muscle strength
Improve balance and joint stability
Exercises:
Heel raises
Toe raises
Resistance-band exercises in all directions
Single-leg standing
Balance board or wobble board training
Mini squats
Step-ups
Functional strengthening
Phase 4: Functional & Return-to-Sport Phase (4–8+ Weeks)
Objectives:
Restore agility and sport-specific function
Prevent reinjury
Exercises:
Jogging progression
Hopping
Jump landing drills
Agility ladder
Figure-of-eight running
Cutting and pivoting drills
Sport-specific training
Use ankle taping or bracing during early return to sport if appropriate.
Manual Therapy
May include:
Talocrural joint mobilization
Soft tissue mobilization
Mobilization with movement (MWM)
Scar tissue mobilization (if indicated)
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Modalities (Adjuncts)
Ice for pain relief (optional)
Compression therapy
Neuromuscular electrical stimulation (selected cases)
Therapeutic ultrasound is not routinely recommended because evidence for improving recovery is limited.
Patient Education
Gradually return to activity
Wear appropriate footwear
Continue balance exercises for several months
Avoid premature return to sports
Maintain a home exercise program
Return-to-Sport Criteria
The patient should have:
Full, pain-free ROM
Minimal or no swelling
Normal muscle strength (≈90–100% of the opposite side)
Good balance and proprioception
Ability to hop, jump, and run without pain
Successful completion of sport-specific functional tests
Summary Table
Phase Main Goals Physiotherapy Treatment
0–3 days Reduce pain and swelling Protection, compression, elevation, gentle ROM, protected weight-bearing
3 days–2 weeks Restore mobility ROM exercises, stretching, strengthening, gait training
2–6 weeks Improve strength and stability Resistance exercises, balance training, proprioception
4–8+ weeks Return to sport Plyometrics, agility, functional and sport-specific training
Key point: Current evidence supports early protected mobilization and progressive exercise therapy rather than prolonged immobilization for most Grade I and II ankle sprains. Balance and proprioceptive training are particularly important for reducing the risk of recurrent ankle sprains.
