An ankle sprain is an injury to the ligaments that support the ankle, usually from a twisting or rolling movement. Most sprains heal well with the right rest, rehabilitation and a gradual return to activity.

An ankle sprain occurs when the strong ligaments supporting the ankle are stretched beyond their limits and tear. Around 90% involve the ligaments on the outside of the ankle, typically from the foot rolling inward during a twist, trip, or awkward step on an uneven surface. Sprains range from tiny tears (Grade 1) through partial tears (Grade 2) to a complete tear with instability (Grade 3).

Nearly all ankle sprains — even complete ligament tears — heal well without surgery when they are protected early and then rehabilitated properly. Treatment follows a staged approach: settling the initial pain and swelling with relative rest, ice, compression and elevation and early weight-bearing as comfortable; then restoring movement, strength and balance; and finally a graded return to normal and sporting activity, sometimes with taping or bracing at first. Depending on severity this takes from around two weeks to a few months.

Our role is to assess the injury, check for anything that needs an X-ray (such as difficulty weight-bearing or bony tenderness), and guide your rehabilitation so the ankle regains its strength and stability. Completing that rehabilitation matters — incomplete recovery is the most common cause of ongoing instability and repeat sprains — and we are clear about the uncommon situations where a surgical opinion is warranted.

Common symptoms

  • Pain, both at rest and with weight-bearing or activity
  • Swelling and bruising around the ankle
  • Tenderness when the injured area is touched
  • A feeling of instability or that the ankle is giving way
Evidence-informed treatment summary

How our treatment options may fit for Ankle Sprain

The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.

Foundation

Diagnosis, education and progressive rehabilitation

This is the starting point for most musculoskeletal conditions.

The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.

Evidence is condition-specific; it is not a universal pain treatment.

Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.

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Evidence varies substantially by condition, tissue and preparation method.

PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.

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Best used for specific inflammatory or irritable pain generators, usually for short-term relief.

An injection may help when a joint, bursa, tendon sheath or other defined structure is driving symptoms. It is not a cure and needs to be weighed against risks, recurrence and the need for rehabilitation.

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Clinical evidence is still developing and guideline support is limited.

EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.

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Selected cases

Prolotherapy

Evidence is condition-specific and generally less established than exercise-based care.

Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.

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Most relevant when focal myofascial pain is a clear contributor.

Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.

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Relevant only when the history and examination support nerve irritation or entrapment.

Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.

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This is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.

Frequently asked questions

How do I know if it is sprained or broken?
A severe sprain can cause similar pain, bruising and swelling to a fracture, so they can be hard to tell apart. If you cannot put weight on the ankle, or there is tenderness over the bones, it should be assessed and may need an X-ray to rule out a break.
What should I do straight after a sprain?
The RICE approach — rest, ice, compression and elevation — in the first 48 hours helps control pain and swelling, alongside early gentle weight-bearing as tolerated. Anti-inflammatories or paracetamol can help with pain.
Why do some ankles keep spraining?
The most common reason is incomplete rehabilitation. If strengthening and balance (proprioception) exercises are stopped too early, the ligaments and control around the ankle stay weak, making repeat sprains and ongoing instability more likely.

Ready for a clearer plan for your back or musculoskeletal pain?

Book an assessment with Dr Joshua Hatch.

Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

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