Ankle Sprains: Evidence-Based Treatment & Rehabilitation Guide

Expert Physiotherapy Insights from Sports Performance Physio

Ankle sprains are among the most common musculoskeletal injuries in sport and active lifestyles, especially in sports involving cutting, jumping and rapid changes of direction.

At Sports Performance Physio in Drummoyne, we manage ankle sprains using up-to-date research and evidence-based rehabilitation principles to support safe and effective return to sport.

In this guide you’ll learn:

• What an ankle sprain is

• How it’s diagnosed

• Best evidence-based rehabilitation strategies

• How to prevent recurrence

• How we approach ankle rehabilitation

What Is an Ankle Sprain?

An ankle sprain occurs when forces applied to the ankle stretch or tear the ligaments stabilising the joint.

This commonly occurs during:

• Sudden changes of direction

• Landing from a jump

• Cutting movements in sport

The lateral (outside) ligaments are most frequently injured, particularly the anterior talofibular ligament (ATFL) during inversion movements.

Other lateral ligaments include:

• Calcaneofibular ligament (CFL)

• Posterior talofibular ligament (PTFL)

Sprains are typically graded:

• Grade I – Mild

• Grade II – Moderate

• Grade III – Severe

based on ligament damage severity.

Typical Symptoms

People with an ankle sprain commonly report:

• Pain and tenderness around the lateral ankle

• Swelling and bruising

• Difficulty bearing weight

• Reduced ankle stability

• Limited range of motion

Prompt and accurate diagnosis is essential to determine severity and guide rehabilitation.

Evidence-Based Diagnosis & Early Management

Best Practice Guidelines

Recent evidence-based clinical practice guidelines highlight:

• Early functional treatment is superior to prolonged rest or immobilisation

• Protection combined with controlled motion improves outcomes

• Bracing or taping during early activity can support healing

• NSAIDs may assist short-term pain control (as advised by your doctor)

If you are unsure about your injury severity, a structured assessment with a sports physiotherapist in Drummoyne can determine the appropriate management pathway.

Rehabilitation: From Acute Injury to Return to Play

Research consistently shows exercise-based rehabilitation is more effective than passive treatment alone.

1. Early Functional Rehabilitation

Early dynamic training including controlled motion and neuromuscular tasks improves return-to-sport timelines compared to passive rest.

Physiotherapy initially focuses on:

• Reducing swelling and pain

• Restoring ankle range of motion

• Initiating safe weight-bearing

2. Progressive Strength & Neuromuscular Training

As pain settles, rehabilitation progresses to exercises that:

• Strengthen peroneal and calf muscles

• Improve balance and proprioception

• Reinforce landing and deceleration mechanics

• Prepare for cutting and hopping

Structured rehabilitation significantly reduces recurrent ankle sprains and long-term instability.

At Sports Performance Physio in Drummoyne, progression is criteria-based — incorporating strength, mobility, balance and sport-specific testing before advancing.

For more detail on our structured ankle rehabilitation programs, visit our Ankle Rehabilitation in Drummoyne.

3. Manual Therapy & Joint Mobilisation

Evidence supports combining manual therapy (joint mobilisation and soft tissue techniques) with exercise to:

• Improve early range of motion

• Restore joint mechanics

• Support return to activity

Manual therapy complements exercise but does not replace progressive loading.

Chronic Ankle Instability (CAI): When Sprains Persist

Up to 40% of people may develop chronic symptoms if initial rehabilitation is inadequate.

Chronic ankle instability may include:

• Recurrent “giving way” episodes

• Repeated sprains

• Balance and proprioceptive deficits

• Ongoing pain with sport

If untreated, CAI may lead to joint cartilage changes and long-term dysfunction.

Targeted neuromuscular and balance training is essential to prevent recurrence.

Preventing Reinjury

To minimise recurrence risk:

• Continue balance and proprioceptive training

• Consider bracing or taping during early return to sport

• Address hip and trunk strength deficits

• Maintain structured loading progression

Many athletes continue to tape or brace during sport to reduce risk.

When to Consider Referral or Imaging

Imaging is generally not required unless:

• A fracture is suspected

• Instability persists despite rehabilitation

• Multi-ligament injury is suspected

• Cartilage or joint surface damage is suspected

In these cases, further evaluation or specialist referral may be required.

Summary: Best Practice for Ankle Sprain Rehabilitation

✔ Early functional rehabilitation with progressive loading is essential

✔ Exercise-based physiotherapy reduces pain and reinjury risk

✔ Manual therapy complements exercise in early stages

✔ Strength and plyometric training support return to sport

✔ Criteria-based progression reduces recurrence

If you have sustained an ankle sprain in Drummoyne or the Inner West, early assessment can significantly improve outcomes.

👉 Book an appointment here: https://www.sportsperformancephysio.com/contact

References (APA 7)

Vuurberg, G., Hoorntje, A., Wink, L. M., et al. (2018). Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. British Journal of Sports Medicine. 

Evidence for rehabilitation interventions after acute lateral ankle sprains in athletes: a scoping review. (2020). PubMed.

Exercise therapy on chronic ankle instability outcomes. (2025). Scientific Reports.

Manual therapy plus exercise for lateral ankle sprains: Meta-analysis. (2025). Journal of Clinical Medicine.