When I was in my teenage years, throughout highschool and in university, I must have picked up at least 4-5 ankle sprains in total. First couple of times I went to emergency when the pain and swelling was severe, I was told to ice it.
Once, I had a similar injury in my knee and I was referred to a physiotherapist, a surgeon, and given referral for imaging, and advised to go through at least a few months of structured physiotherapy and a surgical consult.
Many years later, now, as a physiotherapist practicing in Toronto, I can’t tell you how many young athletes I see with next to no regard for their ankles. I want to take a second and talk about WHY this injury should be taken more seriously.
Many people assume an ankle sprain is a minor injury that will heal on its own. However, research shows that improper management can lead to long-term complications such as recurrent sprains, ankle instability, and chronic pain.
Grade 1 Ankle Sprain: This involves mild stretching or microscopic tearing of the ligaments. Symptoms may include slight swelling, tenderness, and minimal instability.
Grade 2 Ankle Sprain: This refers to a partial ligament tear, often accompanied by moderate swelling, bruising, and difficulty walking. Some instability may be present.
Grade 3 Ankle Sprain: This involves a complete ligament rupture and typically presents with significant swelling, bruising, and noticeable joint instability.
Even Grade 1 and Grade 2 ankle sprains involve real ligament damage and require structured rehabilitation, similar to mild to moderate ligament injuries in the knee.
Knee Ligament Injuries: When patients experience a Grade 1 or Grade 2 knee ligament injury, they are typically advised to rest, undergo structured physiotherapy, and follow a gradual return-to-sport plan.
Ankle Sprains: In contrast, many individuals with Grade 1 or Grade 2 ankle sprains do not seek medical attention. They often return to activity prematurely, assuming the injury is minor and will resolve on its own.
This difference in management highlights a significant gap in care, despite the similar nature of ligament damage in both joints.
Studies show that more than half of individuals who sustain a lateral ankle sprain do not seek formal medical treatment, and many return to sport within days of the injury.
Recurrent Ankle Sprains: Without proper treatment, the risk of repeated injury significantly increases.
Chronic Ankle Instability: Ligament laxity and poor neuromuscular control can lead to ongoing instability and reduced confidence in the ankle.
Persistent Pain and Swelling: Incomplete healing may result in lingering symptoms that affect daily activities and athletic performance.
Reduced Athletic Performance: Impaired strength, balance, and coordination can limit performance and increase injury risk.
Pain: Over the course of physical therapy, an on assessment of pain during activity and over the previous 24 hours ensures the ankle is tolerating functional demands.
Ankle Impairments: Evaluation of range of motion, strength, endurance, and functional jumping/ landing power helps determine readiness for progression.
Perception: Confidence, perceived stability, and psychological readiness are essential factors in safe return to sport.
Sensorimotor Control: Balance, proprioception, and dynamic stability must be restored to reduce reinjury risk.
Sport and Functional Performance: Hopping, jumping, agility drills, and slow progression from drills -> practices -> full participation -> full performance is assessed with clearence criteria for each, depending on the patient’s activity level!
Named as the PAASS framework, this emphasizes that return-to-sport decisions should be based on objective assessment rather than time alone.
Ankle Sprains Deserve Proper Care: and require the same level of attention and rehabilitation as similar injuries in the knee.
Early Physiotherapy Improves Outcomes: Seeking a thorough assessment and treatment plan reduces the risk of recurrent sprains and chronic instability.
Objective Criteria Guide Safe Recovery: Evidence-based frameworks such as PAASS support safe and effective return-to-sport decisions.
I hope that was helpful, if you have experienced an ankle sprain, consult a physician and a physiotherapist well-versed in treating ankle related injuries.
P.S. As far as my own ankle goes, the instability eventually improved after many months of rehab; I just wish I was given proper advice from the beginning!
Arjun Patel, PT, MScPT, MCPA is an orthopedic, neuro, and vestibular physiotherapist. He is the director of Blue Space Clinic Physiotherapy and sees complex cases on a daily basis. He is also an adjunct lecturer at the faculty of medicine at University of Toronto.
To learn more about Arjun and our clinic, click here!
