Ankle Sprains

By: Dale J. Buchberger, PT, DC, CSCS, DACBSP   An ankle sprain is one of the most common sports injuries for athletes who play field or court sports. In fact, according to one of the largest descriptive epidemiological studies of ankle sprain in the United States, the majority of sports related ankle sprains occur during basketball, with football, soccer and running following in descending significance. Sprains can also happen in non-athletes with something as simple as stepping wrong and “rolling” onto the outside of the foot on an uneven surface.

The most common ankle sprain is of the lateral or outside part of the ankle. There are three lateral ankle ligaments that attach the lower leg to the foot, the Anterior Talofibular ligament (ATFL), Calcaneofibular ligament (CFL), and Posterior talofibular ligament (PTFL). These three ligaments are often injured or torn in a lateral ankle sprain.

A lateral ankle sprain occurs when the foot rolls inwards stretching or tearing the ligaments on the outside of the ankle. This commonly happens when an athlete lands on another player’s shoe or someone steps on uneven ground. Once you have sprained your ankle the RICE method of acute treatment should be employed. R-Rest, I-Ice, C-Compression, and E-Elevation. Using an ACE compressive wrap can help keep swelling to a minimum. Applications of ice for 20 minutes every 1-2-hours for the first 24-72 hours will also help reduce swelling and speed recovery. After the first 24-hours performing active icing will also help. While the ice is secured to your ankle and your ankle is elevated, simply move your foot back and forth slowly. The muscle contraction will help move the fluid out of the ankle.

Ankle sprains are graded as follows: Grade I: Ankle sprains are the most mild. The ligaments are stretched and have “microtears”. There is swelling, mild tenderness, and stiffness around the ankle but most people are able to walk with minimal pain.  Grade II: Ankle sprains are more severe. Ligaments are partially torn, and will be tender when touched. A grade II ankle sprain may make walking difficult.  There is more swelling and it is common to have bruising. Grade III: Ankle sprains are the most severe. The ligaments are completely torn, and will be tender when touched. The ankle will be very unstable and you would be unable to bear weight.

Whether you play basketball or walk on uneven ground, there is a simple test that can predict your risk of an ankle sprain. Trojian and McKeag found that a simple, inexpensive screening tool could predict which athletes may be more likely to have an ankle injury. The study found that athletes who were unable to complete a simple single-leg balance exercise were two-and-a-half times more likely to have an ankle sprain during the subsequent season than those who could complete the test.


In this study, 230 college and high school athletes who participated in football, soccer and volleyball were screened during their sports physicals using the Single-leg balance test. The single-leg balance test required that the athletes close their eyes for ten seconds while standing barefoot on one foot, keeping the other knee bent and not touching the weight-bearing leg. The test was considered “positive” if the athlete was unable to perform the test on either one or both legs.


If you play field or court sports and don’t score well on the single-leg balance test, it would be a good idea to take additional preventive measures to reduce your risk of an ankle injury.


Stand on your injured foot and follow these exercises of increasing difficulty.

1) Cross you arms over your chest with your eyes open.

2) Hold your arms out in front with your eyes open

3) Cross your arms over your chest and close your eyes

4) Hold your arms out in front with your eyes closed

Try to hold your balance for 20 seconds working up to 1 minute. Do these exercises 5-6 times per day.


  • Stretching the Achilles tendon should be started soon after sustaining an ankleends of the towel, pulling your toes upwards, and feel the stretch in the back of
  • Once the pain and swelling resolve, physical therapy would focus on regaining, balance, proprioception (joint sense), strength, as well as other modalities to ensure complete healing. Remember, it’s your right as a patient to choose which physical therapist you want to see!
  • the ankle. Perform this stretch for 60-90 seconds, 3-4 times a day.
  • sprain. While seated or lying down, take a towel and loop it around your toes. Pull the