Ankle sprains are a common component of sports related activity through a wide range of endeavors. These are ubiquitous enough that most people will experience an ankle sprain at some point in time. When this happens people often wonder how long it will take to return to their sport or activity. While this can vary based on the degree of severity there are several common factors, but first it is important to establish what is usually involved in a sprain and possibly how to prevent them in the first place.
Typically, ankle sprains involve an inversion of the ankle, many people describe this as “rolling” their ankle. The most common involved structure is the anterior talofibular ligament (ATFL). The reason inversion is more common has to do with the nature of most athletic movements and the structure of the ankle itself. The malleolus (the large, bony ball on either side of the ankle) on the inside of the ankle does not extend as far down as the lateral (outside) of the ankle providing a structure that allows for more inversion sprains.
The clinical practice guidelines for lateral ankle sprains were updated in April of 2021 and help provide clarity on what should be done for treatment of the ankle. The initial priority is protecting the ankle, but rest or inactivity should be short lived - think 10 days or less. Icing can be used, but I seldom recommend this in the acute phase since inflammation is a natural part of healing and the 1st stage in tissue repair.
The best exercises for the ankle usually involve proprioceptive and balancing positions. Think single leg stance on an unstable surface. This will provide the best activation and return of normal firing patterns in the stabilizing muscles. The other update from the latest guidelines involve bracing. A lace-up ankle brace has very good evidence for use following a sprain, in conjunction with ankle specific exercises. I will usually recommend a specific exercise program along with bracing for at least the remainder of the patient’s season. This season could be related to a specific sport or even something like hiking season lasting through the fall.
When discussing prevention of sprains before they have occurred, things have changed some recently. While I am always a proponent of exercise and stability for the ankles, the latest guidelines do not show any reduction in sprains with exercise alone. The recommendation with the highest level of evidence for prevention of ankle sprains is prophylactic bracing. This is the use of a lace up brace with heel straps during activity. This was a big change for my practice in recommendations to patients since my initial inclination was always to avoid bracing unless needed. However, bracing has the best evidence for prevention and represents a new change in how I try to prevent sprains.
Actual return to full activity varies by person and should be done in conjunction with your physical therapist. One thing I consistently recommend is a graded return to activity program. This essentially involves a consistent progression in intensity, time, distance, elevation, etc. Each person is different and will vary individually in what they are able to do without pain.
For my own latest rehab from an ankle sprain, I was able to return to hiking and running fairly quickly. However, riding a road bike while attached to the pedals was painful and irritating.
Recovery from lateral ankle sprains can be a quick process or very long and drawn out depending on the severity of the sprain and the activity each person is trying to return to. The main thing to remember is ankle bracing has the best evidence for prevention of sprains and rehab will involve bracing, balance, strength, and a graded progression.
Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association: Journal of Orthopaedic & Sports Physical Therapy: Vol 51, No 4 (jospt.org