Quick Summary
An acute ankle sprain is a stretch or tear of the ligaments that support your ankle, most often caused by rolling or twisting your foot inwards. It typically causes pain, swelling and bruising on the outer side of the ankle.
The good news is that most sprains respond well to physiotherapy. Our physiotherapists in New Malden combine hands-on treatment with a progressive, exercise-based rehabilitation programme to reduce your pain, restore movement and rebuild stability. Most people benefit from a short course of care — often around 4–6 sessions over 6–8 weeks — depending on the grade of injury and your goals.
What Is an Ankle Sprain?
An ankle sprain is an injury to one or more of the ligaments — the strong bands of tissue that connect bone to bone and stabilise the joint. It is different from a strain, which involves muscle or tendon. The great majority are lateral sprains, caused by the foot rolling inwards (inversion), which stretches or tears the ligaments on the outer side of your ankle.
Ligament anatomy
Three ligaments form the lateral complex. The anterior talofibular ligament (ATFL) is the weakest and by far the most commonly injured, torn in approximately 85% of ankle sprains. The calcaneofibular ligament (CFL) is injured alongside it in more severe sprains, while the posterior talofibular ligament (PTFL) is the strongest and least often injured.
Less commonly, a medial (deltoid) ligament sprain occurs with an outward force, and a high ankle (syndesmotic) sprain injures the ligaments joining the two shin bones above the joint — these take longer to recover and are managed differently.
(Gribble et al., British Journal of Sports Medicine, 2016)
Grading and healing
Sprains are graded I to III. Grade I is a mild stretch or micro-tear with minimal swelling, often settling within 1–3 weeks. Grade II is a partial tear with moderate swelling, bruising and difficulty walking, typically 4–8 weeks. Grade III is a complete rupture with marked swelling and instability, often 8–12 weeks or longer.
Healing follows overlapping phases: an inflammatory phase over the first few days, a repair phase over several weeks, and a remodelling phase lasting months as the ligament regains its strength.
How common are ankle sprains?
Ankle sprains are the most common musculoskeletal sporting injury, with an estimated 302,000 new sprains attending UK emergency departments each year. Importantly, research suggests around 20% of people go on to develop chronic ankle instability and up to 40% experience lasting symptoms — which is exactly why structured early rehabilitation matters.
(Bridgman et al., Emergency Medicine Journal, 2003)
Do You Experience These Symptoms?
✓ Pain on the outer side of your ankle, especially when standing, walking or moving the joint
✓ Swelling that develops within the first few hours of injury
✓ Bruising that may appear over the following days and track towards your foot
✓ Tenderness when pressing over the injured ligaments
✓ Stiffness and reduced range of movement in the ankle
✓ A feeling of instability, or your ankle giving way on uneven ground
✓ Sometimes a pop or snap felt at the moment of injury
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes an Ankle Sprain?
• Sports and recreation
Sudden changes of direction, jumping and landing, or contact with another player can force the ankle into inversion.
Court and pitch sports, running on uneven ground and dancing are frequent culprits.
• Uneven surfaces and missteps
Stepping off a kerb, onto a stone, or into a pothole can roll the ankle in an instant.
Poor lighting, rushing and carrying awkward loads all increase the risk.
• A previous ankle sprain
A history of sprain is one of the strongest risk factors for another one.
Residual ligament laxity and reduced position sense leave the joint more vulnerable.
• Footwear and load
High heels, worn-out trainers or shoes with poor support raise the risk of rolling your ankle.
Carrying heavy loads or being fatigued reduces the control that normally protects the joint.
• Reduced strength, balance or flexibility
Limited ankle dorsiflexion, weak peroneal muscles and poor balance make a sprain more likely.
The risk rises further when a warm-up is skipped or training load increases quickly.
How We Treat Ankle Sprains at J&J Therapy
Hands-On Manual Therapy
Graded joint mobilisation — including anterior-posterior talocrural glides — to restore the ankle dorsiflexion commonly lost after a sprain, combined with soft tissue work to ease pain and muscle guarding.
We begin once a fracture has been excluded and the acute phase settles, and we introduce balance retraining early because a sprain disrupts your joint position sense.
Shockwave Therapy*
Swiss Storz Medical MASTERPULS
is not used for a fresh ankle sprain, as the acute injury involves bleeding, swelling and inflammation.
Where lateral ankle or tendon-related pain persists well beyond the expected healing time (usually 6–12 weeks), radial shockwave therapy may be considered as a second-line option when your assessment indicates it may help. The evidence in chronic ankle conditions is currently limited, so it is never a first-line or stand-alone treatment and is always combined with your exercise programme.
Non-invasive, assessment-based.
Targeted Exercise Programme
A progressive programme restoring dorsiflexion range, strengthening the peroneal and calf muscles that protect against inversion, and retraining balance and proprioception — from single-leg standing through to hopping and sport-specific drills.
Research suggests exercise-based rehabilitation reduces the risk of re-injury over the following 12 months (Wagemans et al., PLoS ONE, 2022). We apply clear return-to-sport criteria before you resume pivoting or impact activities.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Bony tenderness over your ankle bones, the navicular or the base of the fifth metatarsal, or an inability to take four steps (a fracture must be excluded)
Obvious deformity, severe pain or swelling, or an open wound over the joint
Numbness, pins and needles, or a cold, pale or blue foot (possible nerve or blood vessel involvement)
A hot, red, increasingly swollen or painful calf, or fever and spreading redness (possible clot or infection)
FAQs About Ankle Sprains
How long does an ankle sprain take to heal?
It depends on severity. A mild (Grade I) sprain often settles within 1–3 weeks, a moderate (Grade II) sprain in roughly 4–8 weeks, and a severe (Grade III) sprain may take 8–12 weeks or longer. Following a structured rehabilitation programme helps you recover fully and reduces the risk of lasting instability.
Should I rest completely or keep moving?
Current evidence favours early, protected movement over prolonged rest. After a short initial period of protection, gentle loading and movement guided by your physiotherapist generally lead to a better and faster recovery than immobilisation (Kerkhoffs et al., Cochrane Database of Systematic Reviews).
Do I need an X-ray?
Not always. Clinicians use the Ottawa Ankle Rules to decide who needs imaging. If you have specific bony tenderness or cannot walk four steps, an X-ray is advised to exclude a fracture; if not, a fracture is very unlikely.
Can shockwave therapy treat my ankle sprain?
Not in the early stages. Shockwave therapy is not used for a fresh ankle sprain, because the acute injury involves bleeding, swelling and inflammation — and a fracture may not yet have been ruled out — and current research does not support it for acute sprains. If you have ongoing lateral ankle or tendon-related pain that has not settled with rehabilitation, usually after 6–12 weeks, radial shockwave therapy using our Swiss Storz Medical MASTERPULS device may be considered as a second-line option. The evidence in chronic ankle conditions remains limited, so it is never a first-line or stand-alone treatment and is always combined with exercise.
Why does my ankle keep giving way after previous sprains?
Repeated sprains can lead to chronic ankle instability, where weakened ligaments and reduced balance and position sense leave the joint feeling unsteady. This is common but very treatable — a targeted programme of strengthening and balance retraining, alongside manual therapy where appropriate, can meaningfully improve your stability.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
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