Just Sprained Your Ankle? Here is What to Do Next.

Ankle sprains are one of the most common injuries in both sport and everyday life. Whether you rolled your ankle on a trail run, landed awkwardly during a game, or simply stepped off a curb, it's easy to assume that rest is all you need. In reality, how you manage the injury during the first few days can have a significant impact on your recovery and your risk of future ankle sprains.

Do You Need an X-ray?

If you've just twisted or rolled your ankle, your first question is often, "Do I need an X-ray?"

Before rushing to the emergency department, ask yourself these questions:

• Can I take six or more steps on the injured foot? 

• Do I have pain when I press on the bony part of the outside of my ankle (lateral malleolus)? 

• Do I have pain when I press on the bony part of the inside of my ankle (medial malleolus)? 

If you cannot take six steps or you have tenderness over either ankle bone, you should have the injury assessed and may require an X-ray to rule out a fracture.

However, your first stop doesn't always need to be the emergency department.

Physiotherapists are first-line healthcare practitioners who are trained to assess ankle injuries. After a thorough examination, they can determine whether you require an X-ray, an ultrasound, both, or no imaging at all—potentially saving you unnecessary investigations, time, and expense.

Modern Ankle Sprain Management

The management of ankle sprains has changed considerably over the past decade. Current evidence supports less immobilisation and earlier, progressive loading to optimise healing.

While moon boots certainly have an important role in managing fractures and more severe injuries, most ankle sprains do not require one. As the saying goes, moon boots are for walking on the moon—or for serious fractures.

Most ankle sprains can be managed successfully with a lace-up ankle brace, while milder sprains may only require a compression bandage during the early stages. These supports provide stability while still allowing enough movement to encourage healing.

The first 48–72 hours after the injury are particularly important. This is when you should follow the PEACE principles before progressing to LOVE as your symptoms improve.

Follow the PEACE & LOVE Approach

The PEACE & LOVE framework is the current evidence-based approach to managing soft tissue injuries and supporting long-term recovery.

PEACE (First 48–72 Hours)

Protect – Reduce activities that significantly increase pain and avoid movements that place unnecessary stress on the injured ligaments. If recommended, use a lace-up brace or crutches for short-term support.

Elevate – Elevate your ankle above the level of your heart whenever possible to help manage swelling.

Avoid Routine Anti-inflammatories – Inflammation is a normal and necessary part of healing. Routine use of anti-inflammatory medications such as ibuprofen (Brufen®, Nurofen®) or diclofenac (Voltaren®) during the first 48 hours is generally discouraged unless advised otherwise by your healthcare provider. If pain relief is required, paracetamol may be a suitable alternative.

Compress – Use a compression bandage or ankle brace to help control swelling and provide support.

Educate – Understand your injury and seek professional advice early. Complete rest is rarely the answer, and early, appropriate movement is an important part of recovery.

LOVE (After the Acute Phase)

As pain and swelling begin to settle, rehabilitation should become the focus.

• Load – Gradually reintroduce weight-bearing and strengthening exercises.

• Optimism – Maintaining a positive mindset and actively engaging in rehabilitation can improve recovery.

• Vascularisation – Introduce pain-free aerobic exercise, such as cycling or swimming, to improve circulation and promote healing.

• Exercise – Progressive rehabilitation exercises restore strength, mobility, balance, proprioception, and confidence.

The Most Important Step? Rehabilitation

Pain settling does not mean your ankle has fully healed. A successful recovery requires restoring the qualities that help keep your ankle stable and resilient, including:

• Strength

• Balance

• Proprioception (your body's awareness of joint position)

• Mobility

• Confidence during movement

Returning to activity too soon or skipping rehabilitation often results in the ankle feeling unstable, particularly during running, jumping, or changing direction.

The Role of a Physiotherapist in Ankle Sprain Recovery

As a physiotherapist, I believe that we play a vital role in helping you recover from an ankle sprain. While pain and swelling often improve within a few days, the ligaments, muscles, and balance systems need longer to recover and adapt fully.

Following a thorough assessment, your physio, will develop an individualised rehabilitation programme designed to restore proprioception, balance, strength, mobility, and confidence. Rehabilitation should progress according to your stage of healing and your goals—whether that's returning to walking, running, gym training, or competitive sport.

Research suggests that up to 60% of people who sustain a lateral ankle sprain experience another sprain or ongoing ankle-related symptoms, particularly when rehabilitation is inadequate. Without appropriate rehabilitation, many people develop chronic ankle instability, a condition characterised by ongoing instability, recurrent sprains, or a feeling that the ankle repeatedly "gives way."

Unfortunately, each subsequent sprain increases the likelihood of another injury and may contribute to long-term pain, reduced function, and an increased risk of ankle osteoarthritis later in life.

The goal of physiotherapy isn't simply to get you pain-free—it's to restore your ankle's strength, stability, and resilience so you can return to activity with confidence while significantly reducing your risk of future ankle sprains.

The right treatment today will help you get back to walking, running, and sport stronger, more confident, and less likely to sprain your ankle again.

Take Home Message

An ankle sprain may seem like a minor injury, but without appropriate management it can lead to ongoing pain, instability, and repeated sprains. The first 48–72 hours are crucial—protect the injury, avoid unnecessary immobilisation, and follow the PEACE principles before progressing to LOVE as your symptoms improve.

Most importantly, don't stop once the pain settles. A structured rehabilitation programme that restores strength, balance, proprioception, and confidence is essential for a full recovery and significantly reduces your risk of future ankle sprains.

Remember: Pain free doesn’t mean, fit to return to full activity. Don't just let your ankle heal—rehabilitate it.