Ankle Sprains Are Never Just a Sprain

Ankle Sprains Are Never "Just a Sprain"

Ankle sprains are the most common musculoskeletal injury in sport — and also one of the most undertreated. The standard advice to ice it, rest it, and wait for it to stop hurting has produced a remarkably predictable outcome: up to 40% of people who sprain an ankle go on to develop chronic ankle instability, a pattern of recurrent giving-way and persistent symptoms that significantly limits activity for years afterward.¹

The phrase "just a sprain" undersells what's actually happened. A lateral ankle sprain stretches or tears the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), or both. But the injury isn't only to the ligament. Mechanoreceptors in the ankle joint and surrounding structures — sensory organs critical for balance and proprioception — are also disrupted. Without specific rehabilitation to retrain that neuromuscular system, the ligament heals but the ankle's ability to protect itself doesn't.²

What's Actually Being Damaged

A lateral ankle sprain typically occurs with the foot inverted and plantarflexed — the classic mechanism of rolling the ankle on uneven ground, a kerb, or another player's foot. The ATFL is the first structure to fail, followed by the CFL in more severe sprains.

Beyond the ligament damage, the impact on proprioception is significant. The ankle relies heavily on sensory input from the joint capsule, ligaments, and musculotendinous structures to coordinate protective muscle activity — the peroneal muscles firing quickly to resist inversion. After a sprain, this reflex loop is disrupted. The peroneal reaction time slows, postural sway increases, and the ankle is biomechanically less equipped to handle the demands of sport. This is the primary mechanism behind re-injury and chronic instability.¹

The Kinetic Chain Above

Hip and core stability play a more significant role in ankle injury risk than is commonly appreciated. Research has consistently linked reduced hip abductor strength and poor dynamic single-leg balance to lateral ankle sprain rates — particularly in cutting and jumping sports. When proximal stability is insufficient, the forces transmitted to the foot and ankle are less well-controlled, and the ankle is forced to compensate for instability higher in the chain.

An assessment of the full lower limb — hip strength and control, knee mechanics, foot and ankle mobility — provides a more complete picture of why ankle sprains keep happening and what needs to change in the rehabilitation program.

What Rehabilitation Actually Requires

Functional rehabilitation — balance training, proprioceptive exercises, progressive strength and agility work — produces significantly better long-term outcomes than rest and passive treatment alone.³ The neuromuscular system needs to be retrained, not just rested.

Early loading is appropriate for the vast majority of ankle sprains. The RICE protocol remains useful in the first 24–72 hours for symptom management, but prolonged immobilization delays neuromuscular recovery and muscle strength. Protected weight-bearing, single-leg balance work, and peroneal strengthening can begin early and advance systematically as symptoms allow.

There are no exercises that are inherently dangerous for a recovering ankle — only progressions introduced too quickly for the tissue and neuromuscular system to adapt to.⁴ The return-to-sport timeline should be based on functional criteria: restored strength symmetry, single-leg balance, and completion of a graded cutting and landing program — not the calendar.

Preventing the First One and the Next One

Balance and proprioception training reduces ankle sprain rates in high-risk populations. Systematic reviews of neuromuscular training programs — including the FIFA 11+ and similar warm-up protocols — show meaningful reductions in ankle sprain incidence across team sports. Ankle bracing and taping also reduce re-sprain rates in people with a history of previous sprains, and are reasonable adjuncts during return to sport.³

If you've sprained an ankle and it healed on its own without rehabilitation, there's a reasonable chance the neuromuscular deficit is still there — particularly if you notice occasional giving-way, difficulty on uneven ground, or a sense of instability during reactive movements.

The team at Boreal Spine & Sport uses a full kinetic chain assessment for ankle injuries, addressing not just the ankle but the hip and core control factors that influence how the lower limb handles dynamic loading in sport and everyday activity.

References

1. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123–140.
2. Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle instability. Clin Sports Med. 2008;27(3):353–370.
3. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121(4):324–331.
4. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273–280.