Sprained ankle: the first 72 hours and how long recovery takes

What happens in an ankle sprain

An ankle sprain is a stretch or tear of the ligaments that hold the ankle joint together. Most involve the ligaments on the outside of the ankle after the foot rolls inwards, for example stepping off a kerb, landing awkwardly or changing direction in sport. Sprains are graded by how much ligament damage there is:

• Grade 1 – ligament fibres stretched; mild swelling, you can usually walk with some discomfort.
• Grade 2 – partial tear; noticeable swelling and bruising, walking is painful and the ankle may feel unstable.
• Grade 3 – complete tear; significant swelling and bruising, difficulty putting weight through the foot.

Do I need an X-ray?

Most sprains do not involve a broken bone, and an X-ray is not routinely needed. Clinicians use a set of criteria, often called the Ottawa rules, to decide when one is worthwhile. In plain terms, an X-ray is more likely to be needed if:

• you could not take four steps on the foot straight after the injury, and still cannot now
• there is bone tenderness at the back edge or tip of either ankle bone (the bumps on the inside and outside of the ankle)
• there is bone tenderness on the outer edge of the midfoot, or over the top of the inner arch
• there is obvious deformity, numbness, or the foot looks pale or cold

If any of these apply, the ankle should be assessed the same day. You can call us: our clinicians can examine you and, where needed, arrange a fast-track X-ray through our imaging partner, often the same or next day subject to availability (see X-ray and MRI referral). For more severe symptoms, such as an obvious deformity, being completely unable to put weight through the foot, a wound over the ankle or numbness in the foot, go straight to A&E. Call 999 for life-threatening signs.

The first 72 hours: PEACE

Current sports-medicine guidance has moved on from "rest and ice" alone. The PEACE & LOVE approach, published in the British Journal of Sports Medicine, summarises the first few days as follows:

• Protect – reduce activity for one to three days to limit bleeding and further strain, but avoid complete rest; let pain guide how much you do.
• Elevate – raise the ankle above the level of your heart when you can, to help fluid drain.
• Avoid anti-inflammatories – the authors suggest avoiding anti-inflammatory medication and ice in the first days, because some inflammation is part of healing. Ice may still help with pain; ask your pharmacist or GP what is suitable for you.
• Compress – an elastic bandage or compression sleeve may help limit swelling.
• Educate – understand that most sprains recover well with an active approach, and that scans, passive treatments and long periods of rest are rarely needed early on.

Then: LOVE

• Load – start putting weight through the foot and walking normally as soon as pain allows. Gradual loading helps ligaments and tendons recover their strength.
• Optimism – confidence and a positive expectation of recovery are associated with better outcomes.
• Vascularisation – comfortable cardiovascular activity that does not provoke pain, such as cycling or swimming a few days in, may help circulation and mood.
• Exercise – restoring movement, strength and balance is what reduces the risk of spraining the ankle again.

How long recovery takes

Timelines vary with the grade of sprain, your age, general health and how early rehabilitation starts. As a rough guide:

• Grade 1 – often settles in one to three weeks.
• Grade 2 – usually three to six weeks to return to most activities, longer for sport.
• Grade 3 – commonly several weeks to a few months, sometimes with a short period in a boot or brace.

Swelling and some stiffness can linger for longer than the pain. Up to a third of people have ongoing symptoms or repeated sprains after a first injury, which is why rehabilitation matters even when the ankle feels better.

How physiotherapy may help

An assessment confirms the grade of sprain, checks the other structures that can be injured at the same time, such as the calf, the Achilles tendon or the joint surface, and sets out a plan. Treatment may include:

• early advice on walking, protection and swelling control
• taping or bracing in the first weeks, where appropriate
• a progressive programme to restore range of movement, calf and ankle strength, and balance on one leg
• hands-on treatment for stiffness, and adjuncts such as interferential or ultrasound therapy where they fit the plan
• a staged return to running, hopping and change of direction before you go back to sport

The number of sessions depends on the grade and your goals; see our guide on how many physiotherapy sessions you may need. Outcomes vary from person to person.

When to book

Book an initial assessment if you cannot walk comfortably after two or three days, if swelling and bruising are marked, if the ankle feels unstable or gives way, or if a previous sprain never fully settled. For a suspected fracture, call us for a same-day assessment and imaging, or go straight to A&E for more severe symptoms. Our clinic is in Bloomsbury, a short walk from Russell Square and Holborn, and fees are on the fees page.