Download the full plan here and read on for the accompanying material!
Download the full 20 Step Plan
As someone who has suffered from quite a severe ankle sprain and made a few mistakes during the recovery process, I learned quite a bit about what helps boost full sprained ankle recovery but more about what hinders it. One thing I saw a lack of at the start was a clearly defined guide on what to do at each phase of the injury, from the time of occurrence to being able to perform activities again pain-free.
As someone who prefers a structured approach to things like this I found that not having a clear plan made it harder to track progress and in my opinion extended the recovery time. So my idea with this guide was to provide a clear plan with actionable instructions that can be followed step by step and leave the “patient” safe in the knowledge that they’re doing the correct things at the correct times.
I’d just like to point out a couple of important things before you read the guide and accompanying material -
- I’m not a medical professional but I feel the plan I have come with is logical and effective and is based on first-hand experience and extensive reading on sprained ankle recovery
- I’ve split the plan into phases and it’s vital that you only move on to the next phase when you are ready as they increase in intensity
- It’s hard work, and it may even seem boring at times, but if you’re determined and stay committed the result will be worth it!
And so, into the material!
Phase One – Post Injury Phase
Phase One deals with the period immediately following the occurrence of the injury and is perhaps the most crucial in ensuring the ankle heals correctly.
So you’ve just sprained your ankle; you’ve twisted it running, walking down steps or taking part in some other active pursuit. Here’s what you need to do – STOP! If you think about it, the moment you sustain an injury the clock starts ticking, and stops when you are fully fit to resume your activities pain-free. To minimise this time it’s essential that you stop all activity immediately to prevent further damage and through the course of your recovery stick to the rule-of-thumb that if something is painful then lower the intensity or stop altogether.
The body’s first reaction to an ankle sprain is the inflammatory response of swelling. Swelling results from the movement of fluid and white blood cells into the area of inflammation. The pain is caused by the release of chemicals and the compression of nerves in the area. Although swelling is the first stop towards healing, it is important to treat it appropriately at this stage as prolonged swelling can lead to decreased ability to activate the muscles around the joint and ultimately weaken the ankle.
It’s a good idea to keep a gel pack (avaliable at most pharmacies) in your freezer at home in case of emergency as these can be reused when needed, however other frozen items such as a bag of vegetables wrapped in a cloth will suffice. Ice packs can be applied for periods of 15 minutes every two hours in the days immediately following the injury.
First things first, rest is crucial in the very early stages when pain is still severe. In the case of a Grade 3 sprain (explained later) an aircast boot may be used to stabilise the ankle and protect it from further damage, and it may be best to consult a medical professional if you feel this is necessary.
After avoiding weight-bearing activities in the immediate aftermath of the injury, it will be important to gradually re-introduce motion to the foot and ankle. During this time it is essential to remember not to limp as this will adversely affect how the ankle heals, so either maintain a normal walking pattern or, if the pain isn’t bearable, stop weight-bearing activites until the pain level drops sufficiently.
The step by step plan clearly lays out when and how you can start putting weight on your ankle again but it’s important to let your pain level dictate when you move onto more intensive exercises.
Following on from icing to reduce swelling and motion to ensure the ankle regains it’s full flexibility, compression is essential in helping with both of these. Compression not only reduces swelling but adds stability to the ankle to avoid the joint becoming unstable, resulting in a weakened and easily re-injured ankle.
For an easy home made compression wrap use a crepe or elastic bandage and wrap from the toes to just above the ankle and change the bandage approximately every four hours. When resuming activities later it’ll provide extra stability (and confidence) to use an ankle brace.
As you can tell from the first few steps, the early goal is to reduce inflammation and as an optional addition to your recovery program you can use some home remedies which you may not have known have good anti-infammatory properties.
Ten such remedies can be found at this great resource but for the purposes of the step-by-step plan I’ve picked out the most straightforward ones -
- Mix a tablespoon of garlic juice and two tablespoons of warm coconut oil, and gently rub on the affected area. Wash the area with lukewarm water after half an hour. Repeat three or four times a day for several days.
- Alternatively, you can mix a teaspoon of garlic oil and a teaspoon of almond oil. Apply to the affected area two or three times a day and again repeat daily for several days.
- Add one cup of Epsom salt into warm bath water and stir to help the salt dissolve in the water.
- Soak the sprained ankle in the bath water for at least 30 minutes.
- Remove the outer leaves from a head of cabbage.
- Use a rolling pin to gently bruise the leaves so the juices can be released.
- Wrap the cabbage leaves in foil and then warm them in the oven. The leaves should be warm but not hot.
- Put the warm cabbage leaves over the painful area. Secure them in place with a gauze bandage.
- Cover the entire area with plastic wrap to retain its warmth.
- Leave it on for half an hour.
- Heat the olive oil and then allow it to cool for some time. Apply the warm oil on the affected area and gently massage for few minutes. This will relax the muscle and relieve pain. Do this three or four times a day for a few days.
- Add one tablespoon of olive oil to one egg yolk and mix it well. Apply this mixture on the affected area and cover it with a cotton pad. Keep it bandaged for two days. Repeat the process for a few days.
Something to keep in mind when resting, icing, applying compression and during any home remedy treatments is the position of the foot/ankle. Elevating an injury 12 to 18 inches above the heart significantly reduces the blood pressure to the injured tissues and decreases the amount of swelling after injury. So, when sitting or lying down it’s well worth having your foot propped up to give you that extra anti-inflammatory boost. This can be done easily using a stack of pillows or simply the arm of a sofa.
So if you’ve gone through the first six steps then you’re all set for the early stages of your recovery and chances are you’re going to spend a fair bit of time sitting and lying around. This is the perfect time to go over step seven and find out some more about what an ankle sprain actually is – the types, the symptoms and the recovery time – so that you know what you’re dealing with.
An ankle sprain is the result of the ankle liagments being overstretched causing them to tear or partially tear. The most common type of sprain is when the ankle rolls outward and the foot turns inward (inversion) however it’s also possible for a sprain to occur when the ankle rolls inward and the foot turns outward (eversion). Least common is the high ankle sprain which can happen when the foot is forced to rotate toward the outside (away from the other foot), or when the foot is planted so it can’t move and the leg is rotated toward the inside.
Knowing the symptoms will help in determining that the injury is in fact a sprain and isn’t a break in the bone. When a sprain occurs, blood vessels will leak fluid into the tissue that surrounds the joint. White blood cells responsible for inflammation migrate to the area, and blood flow increases as well. Along with this inflammation, swelling from the fluid and pain is experienced. The nerves in the area become more sensitive when the injury is suffered, so pain is felt as throbbing and will worsen if there is pressure placed on the area. Warmth and redness are also seen as blood flow is increased. Also present is a decreased ability to move the joint, and difficulty using the affected leg.
Depending on the severity ankle sprains are classified in grades of one to three. If in doubt, always follow the advice of a professional particularly if you suspect a Grade II or III sprain.
A stretching or slight tearing of the ligament with mild tenderness, swelling, and stiffness. The ankle feels stable, and it is usually possible to walk with minimal pain.
A larger but incomplete tear with moderate pain, swelling, and bruising. Although the ankle sometimes feels stable, the damaged areas are tender to the touch, and walking is painful.
A complete tear of the affected ligament or ligaments with severe swelling and bruising. The ankle is unstable and may feel “wobbly.” Walking is usually not possible because the ankle gives out and there is intense pain, although initial pain may quickly subside.
Regarding recovery time a Grade I sprain will generally take 2-4 weeks, a Grade II sprain will take 6-8 weeks, while a Grade III sprain is a little less predictable given the severity and the level of treatment needed which is why following the advice of a professional is key here.
Putting the timelines from the previous step into the context of the step-by-step plan I’ve provided, this shows why it is essential only to progress between phases when the pain permits and don’t worry about progessing on the specific days if you are unable to – avoiding rushing your recovery will benefit you in the long run, which is something I learned the hard way!
For this reason step eight is there to remind you to properly assess your pain levels before moving from Phase One to Two and from Phase Two to Three.
My Phase One Mistakes
- The crucial mistake I made in Phase One was right at the beginning – I didn’t stop playing! I sustained my injury playing football on a 3G surface after going for a header and landing awkwardly. My foot caught in the ground and the ankle turned leaving me in great pain. it’s a big regret that I didn’t immediately stop at that point and tried to play on, undoubtedly doing more damage.
- After the pain became to much I eventually came off the pitch and rested, however with heavy strapping I played again the next week which was way too early and didn’t give my ankle enough time to heal fully or properly.
- Having worn moulded stud football boots on the 3G surface where I sustained my injury, I’d now recommend flat soled astro turf style trainers for this surface due to the lack of “give” on the 3G. The studs were too easily caught in the ground and I’m convinced this contributed to the rolling of the ankle. The general lesson here is to ensure that with all activites you are using the appropriate equipment and footwear.
Phase Two – Early Rehab Phase
Phase Two is concerned with the early rehabilitation of the ankle which involves increasing mobility and performing important exercises to strengthen the ankle.
Before beginning to put weight on your ankle again and carry out exercises it’s wise to start by choosing a suitable ankle support brace that can be worn to provide stability and prevent re-injury. The brace I used (and still use), and found to be very effective, was the Aircast A60 which provides great stability without restricting the normal motion of the ankle too much.
I’ve also compiled a list of appropriate Aircast braces based on related injuries which you might find useful at this point. It’s located here.
It’s important to start getting the ankle back to it’s regular range of motion as soon as pain permits and the first step at easing into this comes in the form of low intensity activities such as stretches, heel raises and closed-eyes balances. These activities will ensure that you strengthen your ankle and that you have a full range of motion when you have fully recovered.
The exact repetitions and frequency with which you should do these exercises are outlined in the step-by-step plan.
Having gained some confidence from stretching and heel raising activities you should be able to progress to some light stability/wobble board exercises. These types of exercises are very useful for the rotation of the ankle and really starting to get that range of motion back.
As with everything else in this process it’s wise to start slowly so for the early exercises you’ll be seated to avoid putting all your weight on the ankle while it rotates. From there the exercises build up in intensity and will continue to be performed alongside the other activities for the remainder of Phase Two.
Most physiotherapists will include resistance band exercises in any sprained ankle rehabilitation program and these are a highly effective and simple way to build strength in the ankle as it heals. The convenient thing about these strengthening exercises is that they involve very simple pieces of equipment and can be done pretty much anywhere.
Once strength and rotation have been worked on sufficiently the next progression is to introduce some cardio work and get the ankle used to normal operation again. The best place to start here is on the stationary exercise bike as this will put no impact on the ankle while allowing you to feel able to complete more energetic activities.
After the bike you can then start some light jogging provided this doesn’t cause any undue discomfort. Jogging starts with running only in a straight line in order to avoid the stress put on the ankle by turning and then when confidence has been built up sufficiently, turning is slowly introduced into the jogging exercises.
If you’ve made it through the previous Phase Two steps successfully then you’re almost ready to progress to Phase Three and really step things up. As I’ve said throughout, it’s essential to progress only when you’re ready and there’s a couple of actionable tests you can perform at this point to be sure you’re good to go.
- You can walk and jog with no discomfort
- You can hop on one foot with no discomfort
- You can rotate your ankle in a full circle (round-the-world exercise) with no discomfort
My Phase Two Mistakes
- Although I did go through some strengthening exercises during Phase Two, I didn’t have a well defined plan like the one I’ve created and so it was difficult to know what to do and when. This probably prolonged my recovery and perhaps hasn’t allowed my ankle to heal properly due to the pain I still experience.
- Phase Two is a good point to start using an ankle brace, however I only became aware of the Aircast A60 (the brace I continue to use even now) after I’d returned to normal sporting activity. It has made a huge difference considering I still suffer from pain but I can’t help but think if I’d starting using it earlier then I might not even need it now.
Phase Three – Full Sprained Ankle Recovery Phase
Now that you’ve laid the foundations of strengthening the ankle and returning it’s normal range of motion, the final phase of your rehabilitation sees you ramp up the intensity and really gives you confidence putting more pressure on your ankle.
Some of the early jogging and stationary bike work in Phase Two was good to get the ankle moving again after the initial period of incapacity. At this point the level of intensity can be increased towards something near the level you would need for your normal sporting activities. The step-by-step plan outlines both activies and how to build them up over the designated days, and even incorporates some high-intensity interval training for the bike work.
For strengthening and flexibility at this phase, some slightly more difficult exercises are introduced – box plyometrics, simple trampoline exercises and some quick-feet ladder drills. These will really help move your ankle in ways that may have been untested so far and thus will allow you to determine if you’re moving through the course too quickly.
Similar to Step Sixteen, this step ensures you’re testing all possible movements of your ankle by introducing some small running courses that involve varying degrees of twisting and turning. It’s important to remember to drop back a few steps if these exercises are causing pain and in particular you should return to strengthening exercises and jogging in a straight line if the turns prove to be painful.
Assuming this last bout of higher intensity activity has gone well you should now be in a position to declare yourself “fit and ready” or not! If you’ve come through all the previous steps and are now experiencing no discomfort then great, you can proceed to slowly reintroduce yourself to your normal sporting activity. If you’ve followed the previous steps sensibly and found that you’re still experiencing discomfort then it might be best to consult a medical professional if you haven’t already done so and they can make an assessment for any damage that may need to be treated differently.
Well done, you’ve made it through! One of the things most people are guilty of (and I was no exception) is only dealing with an injury when it occurs and not taking some simple steps to prevent it. Obviously it’s impossible to be prepared and prevent every injury but there are some things to think about for ankle injuries and indeed in general.
- Always wear appropriate footwear for the surface of your activity. For example I’ve found that astro turf trainers are much more comfortable and safer on artificial 3G football pitches.
- Always stretch before sporting activity. Stretching the calves can be particularly important in preventing ankle injuries.
- Always consider the benefit of wearing a support brace to add stability. In the case of ankle injuries these can be used in the period immediately after recovery or for longer if needed.
Going through the step-by-step plan for sprained ankle recovery you’ll undoubtedly make a few mistakes, and that’s ok – as long as you learn from them! My problem was that I made mistakes without knowing it and without having the structure of a step-by-step plan to fall back on. The plan is intended to be as simple and actionable as possible so it will be immediately obvious if you make a mistake.
It’s also well worth learning from my mistakes, I made plenty of them!
My Phase Three Mistakes
- I had no set plan for returning to normal sporting activity so in my case it was all a bit rushed as naturally I wanted to return as soon as possible. As such I didn’t build up my running distance, intensity and difficulty of turns. As with some of my other mistakes this probably led to returning to activity sooner than I should have.
- Compression and icing are maintained throughout the step-by-step plan and this was something I didn’t stick to during my recovery. Minimising swelling after each strengthening exercise can really help healing and is something I try to do now even after normal sporting activity.
And that’s it! Thanks for reading, you can download the complete step-by-step plan pdf here and here’s some links to information I’ve compiled on ankle braces/injury types that you might find useful -
My Aircast A60
Ankle Injuries – Types and Treatments
Types of Aircast Ankle Brace
Treatment For Sprained Ankle