Ankle sprains make up 10-30% of all sports injuries, yet most people don’t rehab them properly. I know, because I was one of them.

My Story

I was playing rugby in high school when I went into a tackle. My bodyweight plus a 200-pound opponent folded directly onto my ankle. I heard a massive snap, then immediate, severe pain. My ankle blew up like a balloon.

X-rays ruled out a fracture. I was put on crutches and sent to physio.

This is where I wish things went differently.

What My Rehab Looked Like

I got the “typical” treatment: ultrasound, some range-of-motion work, a few light theraband exercises, and RICE, RICE, RICE (Rest, Ice, Compression, Elevation).

The problem? I never got progressive strengthening. There was no return-to-sport plan. No testing. I was on crutches for weeks and just waiting to feel better.

A decade later, I see the same story with young athletes. The evidence is clear: poor rehab is one of the main drivers of chronic ankle instability, which affects about 30% of people after an ankle sprain. Re-sprains in the first three months are directly tied to incomplete recovery.

Here’s what I’d do differently today.

1. Get Off the Crutches Early

The old approach was to rest and stay off the ankle for weeks.

The evidence now says the opposite: early weight-bearing leads to faster recovery and better outcomes in mild to moderate sprains. This doesn’t mean loading recklessly. Use a brace, tape, or boot for protection in the first few days. But get off crutches as soon as pain allows. Movement helps healing tissue align properly.

Our approach: Weight-bear from day one with support. Crutches for comfort only, not for weeks non-weight bearing.

2. Ditch The RICE Method

RICE was the gold standard for decades. But the doctor who coined the term in 1978 has since walked back his own recommendation.

The updated framework is PEACE & LOVE (British Journal of Sports Medicine, 2019):

PEACE (acute): Protect, Elevate, Avoid anti-inflammatories, Compress, Educate

LOVE (subacute): Load, Optimism, Vascularisation, Exercise

The big takeaway: prolonged icing to “stop inflammation” is outdated. Inflammation is a healing signal. Ice is fine briefly for pain relief, but it shouldn’t be the focus of your recovery.

Our approach: Compress and elevate for the first 48-72 hours, & ice for pain. Once swelling settles, switch to heat and movement to promote blood flow.

3. Have a Return-to-Sport Plan from Day One

The most frustrating part of my rehab was having no plan. I had no target date and no benchmarks.

Return-to-sport decisions should be criterion-based, not time-based. Yet nearly half of all studies still use time alone as the only return-to-sport criteria.

Our approach: Set a target date on visit one. Outline clear phases. Give the patient something to work toward.

4. Strengthen Early & Aggressively

This is the biggest gap in ankle sprain rehab, and it was the biggest gap in mine.

Exercise-based rehab significantly reduces re-sprain rates and prevents long-term instability.

Here’s how we structure it:

Phase 1: Isometrics (Day One)

Pain-free muscle contractions without joint movement. This engages the muscles around the ankle without stressing healing tissue.

Phase 2: Dynamic Strengthening

Progress to full range-of-motion strength work:

• Calf strength: Deficit standing and seated calf raises
• Eversion strength: Resisted eversion (key for lateral stability) & slant board lunges
• Foot & ankle work: Foot bridge work, tibial raises, toe walking
• Balance & proprioception: Foam pad balance and Y-balance drill

Goal: >80% on the Star Excursion Balance Test (involved vs. uninvolved side) before progressing.

Phase 3: Plyometrics

Before starting plyometrics, the patient should have: full pain-free range of motion, symmetrical balance, and near-full ankle strength.

Progress from low to high intensity, bilateral to single-leg:

 

Level	Exercise
1	Band-assisted hops
2	Pogos (bilateral)
3	Single-leg hops
4	Multidirectional hops
5	Broad jumps
6	Drop jumps
7	Single-leg drop jumps
8	Bounding
9	Lateral bounding
10	Triple hops & change of direction

 

5. Test Before You Return to Sport

Don’t guess. Test.

The injured limb should perform at at least 80-90% of the uninjured limb before returning to sport.

Our testing battery at Forte Physical Therapy:

• Isometric Calf Strength Test
• Lateral Hop Test (90% LSI target)
• Figure-8 Hop Test
• Single-Leg Hop Test (Force Plates) – Reactive Strength Index
• 5-10-5 Agility Test

Plus a patient-reported outcome measure like the Cumberland Ankle Instability Tool (CAIT) or Foot and Ankle Ability Measure (FAAM).

The Bottom Line:

Ankle sprains are not minor injuries. Over 70% of people have lingering symptoms after their first one, and “rest and wait” isn’t a plan.

If I could go back and talk to my 17-year-old self:

• protect it briefly,
• load it early,
• strengthen it progressively,
• and earn your way back to sport & pass the tests

That’s what I do with every patient now.

 

BOOK AN APPOINTMENT WITH TANNER

By: Tanner Bishop

Physiotherapist, CSCS, MSc PT, BSc Kine, NCCP Coach