PT Tip of the Month Archive

Ankle Sprains

Ankle sprains are one of the most common injuries in athletic and recreational activities. Many people will make a full recovery after spraining their ankle. However, ankle sprains that are left untreated can often lead to chronic pain and instability. Inversion ankle sprains, where the foot is “rolled” inward, are the most common and will be discussed here.

Ankle Anatomy

A ligament is a fibrous tissue that connects one bone to another. Ligaments are the primary source of stability for any joint and the ankle has many. The lateral ligaments around the outside of the ankle are sprained and often torn with an inversion injury. These ligaments include the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). The lateral malleolus, which is the round bone protruding from the outside of your ankle, serves as the origin of these ligaments. The CFL begins here and then attaches to the calcaneus (heel bone). Both the ATFL and PTFL begin here as well but then attach to the talus (a bone in the center of the ankle).

Ankle sprain anatomy

Classification of Ankle Sprains

Lateral ankle sprains occur in three different grades. A grade I ankle sprain is a mild injury in which the ligaments are stretched but not torn. Typically there is little pain and swelling with minimal or no limitation in your usual activity. A grade II sprain involves partial tearing of the ligaments. This results in moderate pain, swelling, bruising, and limitation in activity. A grade III sprain involves complete tearing of the ligaments (typically ATFL and CFL). Severe pain, bruising, and swelling will accompany this type of sprain. Most individuals are unable to bear weight on the ankle. With this type of sprain an x-ray may be indicated to rule-out the possibility of an ankle fracture.

Mechanism of Injury

A severe ankle sprain can occur at the highest level of athletic competition or with a simple misplaced step while walking. Regardless of how you sprain your ankle, the way in which the injury occurs is usually the same. The mechanism of injury is typically an inward rolling (inversion) of a foot pointed downward (plantar flexed). The ankle is least stable in this position and is thus most likely to be sprained. When the ankle is sprained in more of an upward-flexed position (dorsiflexion), more force is required to tear the ligaments. However, damage to more than one ligament is likely when a sprain does occur in this position.


Immediately after an ankle sprain occurs, the PRICE method (protection, rest, ice, compression, and elevation) of treatment should be followed. If your symptoms do not improve within a few days of this conservative treatment and you are still having difficulty bearing weight on the ankle, you should contact your physician. If appropriate, your doctor may refer you to physical therapy. Current literature supports physical therapy as the preferred method of treatment for ankle sprains, allowing for an earlier return to work and activity, compared to immobilization in a cast.

One of our skilled physical therapists can evaluate the extent of your ankle sprain and create an individualized plan of care based on your needs and stage of healing. Initially, your treatment may consist of modalities to help decrease your pain and inflammation while initiating gentle range of motion exercises. As your symptoms improve, treatment focused on strengthening, balance, endurance, and weight-bearing will be introduced. Please contact one of our two locations if you have questions regarding the treatment of your ankle sprain.
33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282