Ankle Sprain Rehabilitation: Stages, Exercises and Return to Sport

Rolling your ankle can happen in a moment. Recovering the strength, balance and physical capacity required for sport can take considerably longer.

Ankle sprains are particularly common in sports such as football, netball, basketball and volleyball, but they also occur during everyday activities such as walking on uneven ground.

Many people find that the initial pain and swelling improve relatively quickly. They can walk comfortably, perhaps jog, and begin to feel that the injury has resolved.

But there is an important difference between an ankle that is comfortable during everyday activity and an ankle that is prepared for running, jumping, landing and rapid changes of direction.

This is where structured ankle rehabilitation becomes valuable.

At RHP Physiotherapy in Kelvin Grove, Brisbane, our sports physiotherapists help people progress from acute ankle injuries through strength, balance, running, jumping and return-to-sport preparation.

This guide explains the main stages of ankle sprain rehabilitation, exercises that may be useful and how we can assess readiness to return to sport.

Why Is Rehabilitation Important After an Ankle Sprain?

An ankle sprain involves injury to one or more ligaments supporting the ankle.

The most common type is a lateral ankle sprain, involving ligaments on the outside of the ankle, often after the foot rolls inward.

However, not every ankle injury is a simple lateral sprain.

Some injuries involve the syndesmosis, commonly called a high ankle sprain. Others may involve fractures, cartilage damage or associated tendon injuries.

Accurate assessment matters because these injuries can require different treatment and rehabilitation pathways.

Our Foot & Ankle Physiotherapy service provides assessment and treatment for ankle sprains, persistent ankle pain and other foot and ankle conditions.

Following a typical lateral ankle sprain, several physical qualities may be affected:

• Ankle range of motion.
• Calf and ankle muscle strength.
• Balance and proprioception.
• Single-leg stability.
• Jumping and landing capacity.
• Running and change-of-direction ability.
• Confidence in the injured ankle.

The aim of rehabilitation is to progressively restore the qualities that matter for the person's daily activities, work and sport.

The Five Stages of Ankle Sprain Rehabilitation

We can organise ankle sprain rehabilitation into five broad stages.

These stages overlap and should not be interpreted as fixed timelines. Someone with a mild sprain may progress relatively quickly, while a more significant ligament injury can require a considerably longer rehabilitation period.

The important principle is that progression should reflect physical capacity, injury severity and the demands of the activity, rather than relying on the calendar alone.

Stage 1: Early Ankle Sprain Rehabilitation

Early rehabilitation begins with establishing what has been injured and how much protection it requires.

For many uncomplicated lateral ankle sprains, contemporary clinical guidelines recommend progressive weight-bearing and appropriately protected movement.

This may include:

• Using a brace or supportive taping where appropriate.
• Progressive walking and weight-bearing as tolerated.
• Gentle active ankle movement.
• Early low-load strengthening.
• Managing pain and swelling to support movement.
• Gradually restoring normal walking.

More significant injuries may temporarily require crutches, a walking boot or a period of greater protection.

The goal is not to force movement through significant pain, but neither is it necessarily to immobilise every sprained ankle for weeks.

Should You Rest an Ankle Sprain Completely?

Not usually for an uncomplicated lateral ankle sprain.

After an initial period of protection, appropriately graded loading generally forms an important part of recovery.

Muscles, tendons and the broader movement system benefit from progressive activity. The appropriate starting point depends on the injury.

For more severe ligament injuries or associated fractures, the management plan may be different.

Restoring Ankle Range of Motion

One of the common limitations after an ankle sprain is reduced dorsiflexion, or the ability to bring the knee forwards over the foot.

This can be noticeable during:

• Walking downstairs.
• Squatting.
• Lunging.
• Landing.
• Running.

Mobility exercises may include active ankle movements, controlled lunges and progressive loaded dorsiflexion.

Where appropriate, joint mobilisation or other manual therapy can help improve pain and movement in the short term.

However, manual therapy is generally an adjunct to rehabilitation rather than a substitute for exercise.

We also do not need every person to achieve an identical dorsiflexion measurement.

The more meaningful question is whether the ankle has sufficient movement for the activities the person needs to perform.

Stage 2: Rebuild Ankle Strength and Proprioception

Once the ankle tolerates more loading, rehabilitation increasingly focuses on rebuilding strength and movement capacity.

This includes the muscles directly around the ankle and foot, but it may also involve the knee and hip depending on the athlete's presentation.

The key areas commonly include:

• The calf muscles, including gastrocnemius and soleus.
• The fibularis muscles, also known as the peroneals.
• The muscles responsible for ankle inversion and dorsiflexion.
• The intrinsic muscles of the foot where relevant.
• The broader lower-limb musculature.

Calf Strength After an Ankle Sprain

Calf strength is particularly important for running, jumping and rapid changes of direction.

While walking can return relatively quickly, the calf may still lack the strength or endurance required for higher-demand activity.

Exercises may progress through:

• Double-leg calf raises.
• Single-leg calf raises.
• Bent-knee calf raises.
• Loaded calf raises.
• Faster calf movements and eventually hopping.

We want the calf to become capable of producing meaningful force and tolerating repeated loading.

That is more informative than simply being able to complete a few bodyweight heel raises.

Peroneal Strength and Ankle Control

The peroneal muscles, now commonly referred to as the fibularis muscles, are located along the outside of the lower leg.

They contribute to ankle eversion and help control the ankle during movement.

Resistance-band exercises can be useful early in rehabilitation, particularly when weight-bearing exercises are still uncomfortable.

As the ankle improves, more demanding standing, single-leg and multidirectional exercises can progressively replace or complement basic band work.

The aim is not merely to strengthen one muscle group in isolation.

It is to improve the ankle's ability to manage force during real tasks.

What Is Proprioception and Why Does It Matter?

Proprioception describes the nervous system's ability to detect information about joint position and movement.

It contributes to how we coordinate and adapt movement without needing to consciously watch every joint.

After an ankle sprain, some people experience changes in joint-position awareness, balance and sensorimotor control.

These effects vary between individuals, and not every ankle sprain causes the same deficits.

Balance and proprioceptive exercises may help restore these qualities.

Examples include:

• Single-leg standing.
• Single-leg balance with head or arm movements.
• Reaching while balancing.
• Single-leg squat variations.
• Balance tasks on different surfaces.
• Progressive hopping and landing.

More advanced balance tasks should be selected for a reason, rather than assuming standing on the most unstable surface available is always better.

Should Both Legs Be Equally Strong?

Comparing the injured ankle with the opposite side can be useful, particularly for calf strength, endurance and hopping performance.

However, there is no universally validated requirement that every measure must achieve exactly 100% symmetry before return to sport.

We need to consider:

• The demands of the sport.
• Absolute strength and endurance.
• Previous testing where available.
• Between-leg differences.
• Symptoms and confidence.
• The athlete's performance during sport-specific tasks.

Symmetry is useful information. It is not the entire decision.

Stage 3: Return to Hopping, Landing and Running

For an athlete, comfortable walking and good basic balance are only part of the recovery.

The next challenge is preparing the ankle to repeatedly absorb and produce force.

This may involve progressing through:

• Double-leg jumping.
• Double-leg landing.
• Single-leg hopping.
• Repeated single-leg hops.
• Forward, lateral and multidirectional hopping.
• Jogging.
• Faster running and acceleration.

Exercises should become more demanding as the athlete develops sufficient capacity.

At RHP, objective strength testing and jump assessment can help us understand how the injured side is progressing where those measurements are relevant.

When Can You Start Running After an Ankle Sprain?

There is no single date that applies to every ankle sprain.

A mild injury may allow a relatively quick return to running, while a more significant ligament or syndesmosis injury can take considerably longer.

Before beginning a running progression, useful considerations include:

• Comfortable walking.
• Adequate ankle movement.
• Good tolerance to calf strengthening.
• Ability to tolerate appropriate impact tasks.
• Minimal problematic swelling or pain response.
• Confidence in loading the injured ankle.

The progression may begin with short jogging intervals before gradually increasing duration, pace and intensity.

For people returning to recreational or competitive running, our Running Physiotherapy service can help guide a progression relevant to their previous running volume and goals.

What If the Ankle Swells After Exercise?

Some symptoms can occur during the rehabilitation process, particularly while activity levels are increasing.

That does not automatically mean further ligament damage has occurred.

However, repeatedly developing significant swelling, increasing pain or reduced function after training may suggest that the current exercise dose is too demanding or that the injury needs reassessment.

The aim is to progressively build capacity while considering how the ankle responds during and after exercise.

Stage 4: Sport-Specific Ankle Rehabilitation

Sport introduces demands that are often absent from basic rehabilitation exercises.

A footballer needs to sprint, plant their foot, change direction, kick and manage contact.

A netballer needs to repeatedly jump, land, pivot, decelerate and react to other players.

A volleyball player needs to tolerate repeated take-offs, landings and rapid lateral movements.

Therefore, rehabilitation should eventually reflect the activities the athlete wants to return to.

Sport-specific ankle rehabilitation may include:

• Higher-speed running.
• Acceleration and deceleration.
• Planned cutting and change of direction.
• Reactive cutting.
• Repeated jumping and landing.
• Movement under fatigue.
• Sport-specific skills.
• Gradual return to appropriate contact or competition situations.

The progression often moves from predictable movements towards less predictable environments.

This can involve reacting to a ball, another player or an external cue rather than always knowing what movement comes next.

For athletes playing court and field sports, our Netball Physiotherapy, Football Physiotherapy and Volleyball Physiotherapy services provide sport-specific rehabilitation pathways.

Stage 5: Return to Sport After an Ankle Sprain

One of the most important questions in ankle rehabilitation is deciding when the athlete is ready to return to competition.

Being pain-free during walking is not necessarily sufficient.

Likewise, having good ankle movement or achieving an isolated strength score does not guarantee readiness.

In 2021, an international group of clinicians and researchers developed the PAASS framework to identify the main domains worth assessing when making return-to-sport decisions after a lateral ankle sprain.

The PAASS Framework for Return to Sport

PAASS considers five areas:

• P — Pain: Pain during sport participation and over the previous 24 hours.
• A — Ankle Impairments: Ankle movement, muscle strength, endurance and power.
• A — Athlete Perception: Confidence, perceived stability and psychological readiness.
• S — Sensorimotor Control: Balance, proprioception and dynamic postural control.
• S — Sport/Functional Performance: Hopping, jumping, agility, sport-specific drills and the ability to complete a full training session.

The framework is useful because it recognises that return to sport involves more than the condition of the injured ligament.

However, it is a consensus framework rather than a fully validated pass-or-fail scoring system.

There is no universal PAASS score that guarantees an athlete will not experience another sprain.

Return-to-sport decisions should consider the individual athlete and the physical demands of their activity.

Do You Need to Complete a Full Training Session Before Returning to Competition?

For many team-sport athletes, tolerating a full training session is an important milestone.

A player may perform well during controlled rehabilitation exercises but still struggle with the intensity, fatigue or unpredictable movements involved in training.

Progressing through modified training and then full training can help establish confidence and physical readiness before competition exposure increases.

Our Return to Sport service can include objective strength and physical performance testing alongside sport-specific rehabilitation.

How Long Does Ankle Sprain Rehabilitation Take?

The timeline varies considerably depending on the severity and type of injury, the person's previous health and the physical demands they need to return to.

Some mild ankle sprains improve sufficiently for a return to activity within days to a few weeks.

Moderate or more significant ligament injuries can require several weeks or months of rehabilitation.

High ankle sprains, associated fractures or more complex injuries may take longer and require a different management pathway.

Importantly, the time needed to resume sport may be shorter than the time required to restore every aspect of ankle function.

It is therefore more useful to assess:

• Symptoms and swelling.
• Ankle movement.
• Strength and endurance.
• Balance and sensorimotor control.
• Running and jumping capacity.
• Confidence.
• Sport-specific performance.

Rather than using the date of injury as the only guide, rehabilitation should progressively establish readiness for the next physical demand.

How Can You Reduce the Risk of Recurrent Ankle Sprains?

One reason ankle sprain rehabilitation deserves attention is that a previous ankle sprain is associated with an increased likelihood of another injury.

Older research described approximately a twofold increased reinjury risk in the year following an initial ankle sprain, although the actual risk varies between populations.

Rather than assuming a fixed recurrence percentage applies to everyone, it is more useful to focus on the strategies supported by clinical research.

Balance Training Can Reduce Recurrence

A randomised controlled trial published in the BMJ investigated an eight-week home-based proprioceptive training program following a sports-related ankle sprain.

The study involved 522 athletes and found that the balance-training group experienced approximately a 35% relative reduction in recurrent ankle sprains over the following year compared with usual care.

This does not mean that every athlete who performs balance exercises will experience exactly that reduction.

But it reinforces the value of continued proprioceptive and balance training after the initial symptoms have improved.

Do Ankle Braces and Taping Help?

Yes, they can.

Clinical guidelines support external ankle bracing or appropriate taping for reducing the risk of subsequent ankle sprains, particularly in people with previous injuries.

The choice depends on:

• Previous injury history.
• The sport being played.
• Comfort and preference.
• The level of support required.
• Practical factors such as footwear and cost.

A brace does not necessarily need to replace rehabilitation.

For many athletes, external support and exercise can be complementary strategies.

Should Ankle Exercises Continue After Returning to Sport?

For many people, yes.

However, there is no universal rule that ankle rehabilitation must continue for exactly six weeks after the first game.

Some athletes may benefit from a longer period of dedicated balance or strength training, particularly if deficits remain or they have a history of repeated sprains.

Others may incorporate those physical qualities into their normal gym training, warm-up or sporting preparation.

The goal is to maintain the capacity developed during rehabilitation rather than completing an arbitrary number of weeks and then stopping everything.

What If Your Ankle Still Feels Unstable Months Later?

Some people experience persistent symptoms after an ankle sprain.

These may include:

• Repeated ankle sprains.
• A sensation that the ankle gives way.
• Reduced confidence on uneven ground.
• Difficulty hopping or changing direction.
• Ongoing swelling or pain.

Persistent symptoms may be associated with chronic ankle instability, although other diagnoses can sometimes contribute.

Chronic ankle instability involves more than a ligament that feels loose. It may include mechanical, strength, balance, sensorimotor and perceived-stability components.

For a more detailed discussion, see our article on chronic ankle instability and rehabilitation.

Persistent giving way, worsening pain or an ankle that is not progressing as expected should be reassessed rather than simply repeating the same exercises indefinitely.

Frequently Asked Questions About Ankle Sprain Rehabilitation

Ankle Rehabilitation in Kelvin Grove, Brisbane

At RHP Physiotherapy in Kelvin Grove, our approach to ankle rehabilitation considers the injured tissue alongside the person's strength, movement capacity, sporting demands and goals.

Depending on the presentation, rehabilitation may include:

• Clinical assessment and diagnosis.
• Guidance on early loading and protection.
• Manual therapy where appropriate for pain or movement limitations.
• Progressive calf and ankle strengthening.
• Balance and proprioception exercises.
• Objective strength and jump testing.
• Running, landing and agility progressions.
• Sport-specific return-to-training preparation.

Our Foot & Ankle Physiotherapy service supports the assessment and management of ankle injuries, while our Sports Physiotherapy and Return to Sport services help athletes rebuild towards their sporting demands.

For athletes recovering from an ankle sprain, the aim is not simply to get the ankle comfortable again.

It is to restore enough strength, movement capacity and confidence for the activities they want to return to.

Author in the know

Sam Donaldson

Director, APA titled Sports and Exercise Physiotherapist. Sam loves to treat athletes with lower limb injuries and has a special interest in knees of all ages; adolescent knee pain, athlete with knee pain, ACL injuries, ACL rehabilitation, Knee Osteoarthritis and Knee Replacement recovery. He is a Dad, Football enthusiast and loves to move. BAppSci (HMS), MPhtyStudies, MPHTY (Sports)