Ankle Sprain Rehabilitation: Physio Tips to Guide You through this Step!

Do you have a sprained ankle, or are you a physiotherapist or doctor with questions about rehabilitation? What are the different stages, the protocol? Are there any exercises that must be done at all costs? How many physiotherapy sessions? What if I have a severe sprain?

Here, I provide answers to the most frequently asked questions. Based on my experience as a physiotherapist, and extensive documentary research: at the end of the article, you’ll find the scientific publications on which I draw.

Enjoy your reading!

♻️ Last update: September 15, 2025
Written by Nelly Darbois, physiotherapist and scientific editor

What is the rehabilitation protocol for an ankle sprain?

A rehabilitation protocol is like a recipe.

To make an omelette, there are a few basic ingredients (well, mostly one 🥚!). But you’ll find a huge number of possible variations , depending on your tastes, your desires, what you’ve got in your cupboard…

It’s exactly the same for rehabilitation. There are a few guidelines to follow, which I’ll tell you about.

But behind them you’ll find an astronomical number of different protocols and exercises. Like a recipe: because not everyone has the same desires, or the same specific problems.

Here are the broad outlines of this very general protocol:

• For the first few days (or weeks), it’s usual (but not systematic) to experience pain, swelling and instability. It’s important to find a way of remaining as active as possible, without aggravating the pain or instability too much;
• as the days or weeks go by, the ankle is less painful, less swollen and less unstable. It is then possible to gradually resume all previous physical and sporting activities.

And that’s all there is to it!

I couldn’t give you a more precise “standard protocol”. Because that would be appropriate for some people, and not for others.

Or that would be one possible version, but there would be many others too! Hence these broad outlines, which really do sum up the essentials, and the common denominator in all ankle sprains.

You’ll find more information on pain after ankle sprains, swelling after ankle sprains and when and how to resume walking after a sprain in some of my other articles.

An ankle rehabilitation protocol is divided into 2 stages: the first involves trying to remain as active as possible without increasing pain, swelling and instability, while the second allows you to gradually resume all your previous physical and sporting activities.

Sources: Doherty, 2017; Tran, 2020.

What is proprioceptive rehabilitation of the ankle?

Proprioceptive rehabilitation means rehabilitation of proprioception.

Proprioception is our ability to identify our body’s movements, strength and position. It is sometimes described as our 6th sense (like taste, smell, etc.).

We all have this ability to varying degrees. And when we have an injury like a sprain, our proprioception is a little less good.

This is one of the reasons for our ankle’s instability.

Re-educating proprioception means trying to regain our ability to identify our body’s position, strength and movements. Most exercises that train strength, flexibility or balance actually involve proprioception!

To varying degrees. When we close our eyes, for example, our proprioception is more solicited, as we cannot compensate by sight.

That’s why physiotherapists often do exercises with their eyes closed.

There are an infinite number of ways to “work on proprioception”:

• walking on sand or other unstable surfaces;
• do exercises on one leg, or with eyes closed;
• use proprioception equipment: gymballs, balance trays or mats, pimple bases, freeman trays, trampolines, etc.

The key to rehabilitating proprioception is, as always, to do things adapted to your current level, and to gradually increase the difficulty. It doesn’t necessarily have to involve specific exercises or equipment: everyday activities can suffice.

What do the studies say about this? Do groups of people who do specific proprioceptive re-education exercises recover better/quicker or have fewer sprain recurrences than those who don’t?

• A Canadian research team has summarized all the studies on the subject (Tran 2020). It concludes that, no, these people with specific rehabilitation do not recover faster or better. There is some uncertainty about recurrence, but I’ll explain why I think this is the case later in the article.
• Another research team has compiled all studies on proprioceptive rehabilitation forchronic ankle instability following a sprain (10-20% of people who have had a sprain are in this situation) (Cochrane 2011). Conclusion: people undergoing rehabilitation at this stage perform slightly better on clinical tests of functional instability. But we have no idea whether this lasts over time, and above all, whether it has a significant impact on their daily lives.

Does rehabilitation necessarily involve exercise?

When we hurt ourselves somewhere (like a sprain), our reflex is often to ask ourselves what exercises we can do. Thinking that by doing specific exercises, you’ll recover faster or better.

Or even that you have to exercise to heal.

That’s a positive attitude 👏 :

• you take it to heart to recover well;
• you’re ready to take active steps to get there.

The question is: are these exercises really essential? Here’s my quick answer to that question: no, the important thing is to gradually reintegrate all your previous activities, in the right proportions.

What we mean by “rehabilitation” is not reduced to “doing exercises”. It’s about “gradually getting back to your old life”.

When your physiotherapist gives you exercises for ankle sprains, they often aim to :

1. maintain or regain ankle flexibility;
2. strengthen ankle muscles;
3. work on proprioception: your ankle’s ability to adapt to the environment to maintain your balance.

But these 3 things you do simply by walking in different situations, climbing stairs, doing household chores and so on. And then getting back into sport.

That’s why, with my patients, I give priority to encouragement and guidance in order to gradually reintegrate these everyday activities. In my opinion, exercises for ankle sprains are only necessary in rare situations:

• significant anklestiffness , even though there is virtually no swelling/oedema. As long as you have swelling, it prevents you from bending the ankle properly anyway, even if you do lots of exercises!
• A person who stays in bed all day and night without really doing anything at all except going to the toilet.

But of course, in other cases, I still give exercises, especially to meet my patients’ expectations! And that’s what I’m going to do now 🙂.

Well, I’m not the only one who thinks so… Here’s the conclusion of a Canadian research team.

Based on the results of systematic reviews comparing structured rehabilitation based on exercise plus usual care versus usual care alone, or supervised rehabilitation versus home exercise, there were no significant differences between treatment groups in terms of foot and ankle function, pain, subjective ankle instability or subjective recovery. Results regarding ankle sprain recurrence were mixed. Specifically, one systematic review showed a significant reduction in ankle sprain recurrence in those who received exercise-based rehabilitation plus usual care compared with usual care alone after 7-12 months, but not after 3-6 months of follow-up. In the other systematic review, one study showed that there was a significantly lower proportion of patients with ankle sprain recurrence in the supervised rehabilitation group compared with the home exercise group, while the other study found no significant difference between the groups.

Canadian Agency for Drugs and Technologies in Health, 2020

Put more simply: with or without exercise, people recover in the same way. There’s a little less certainty about the risk of recurrence.

But with the biases of the publication system tending to publish more studies that show an interest in something, I think it’s more reasonable to believe that there’s no significant effect of exercise on recidivism risk either.

Examples of exercises after ankle sprains

You’ll already find an astronomical number of videos and articles on the Internet proposing exercises for ankle sprains. Here’s a simple infographic to give you an idea of some of the infinite number of possible exercises.

Many variations are possible, but in my opinion, it’s best to resume your daily activities gradually!

And if you really do have a particular limitation, then you’ll need to find targeted, personalized exercises. Although time will undoubtedly take its toll, whatever you do!

How many physiotherapy sessions are needed for a sprained ankle?

In France, rehabilitation sessions delivered by a physiotherapist are often prescribed by doctors who diagnose an ankle sprain.

Maximum number of physiotherapy sessions

In France, the Assurance maladie and the Haute autorité de santé set the maximum number of physiotherapy sessions that people are entitled to for certain common pathologies.

This is the case of the acute lateral/external ankle sprain (which has just arrived).

A maximum of 10 physiotherapy sessions are possible for a sprained ankle.

Even if this number is not written on the prescription.

It is possible to do more if your physiotherapist makes a”request for prior agreement”. Basically, a letter arguing that you need more.

In practice, this restrictive framework is very often not applied (not necessarily voluntarily). In fact, all it takes is a prescription for a chronic sprain or chronic instability, and you’re out of the limited sessions framework!

Can you do your own rehabilitation?

This is the case for many people who don’t necessarily consult a physiotherapist after an ankle sprain.

Of course, just because others are doing it doesn’t mean it’s right to do so.

But as I explained earlier, it doesn’t seem that people with supervised rehabilitation recover better or faster on average.

If going to the physiotherapist is a hassle for you, or if you can’t find an appointment, you can certainly do without one.

On the other hand, if you have a lot of questions, or if you’re feeling lost, you’ll undoubtedly benefit from the expertise of a physiotherapist!

Are there any differences in rehabilitation if you have a severe ankle sprain?

First, let’s agree on what a “severe ankle sprain” is. There are 3 degrees of “severity” in an ankle sprain:

• stage or grade 1 sprain, also known as a “minor sprain” in everyday language. The ligament has only been stretched, but not torn, or only a few fibers. It still performs its role of stabilizing the ankle;
• stage or grade 2 sprain, also known as medium severity. The ligament is partially ruptured over part of its width. It no longer provides adequate stability for the ankle: the bones are no longer sufficiently supported by it;
• stage or grade 3 sprain, also known as severe ankle sprain. The ligament is torn across its entire width. It is the insertion of the ligament on the bone that is torn away, hence the use of the term bone tear to designate this type of sprain.

A general rule: all other things being equal, stage 1 sprains will recover faster than stage 2 and 3 sprains; stage 2 sprains faster than stage 3 sprains.

But the rules in medicine are like those in French grammar: there are always exceptions, or variations according to different parameters, which we can’t necessarily identify. For example, the evolution of pain is not linked to the severity of the sprain !

And the data on recovery according to severity after a sprain are contradictory: it is not certain that people with an egrave sprain (a ruptured ligament) recover less well or more quickly! (Pepper 2008)

So rehabilitation doesn’t necessarily depend on the severity of the injury. It’s more a question of adapting to the way you’re progressing.

A person with a mild sprain but very severe pain is unlikely to walk much. Conversely, a person with a severe sprain but little pain and walking instability will walk more at the same stage.

What self-rehabilitation tips are there for ankle sprains?

The best advice I can give you is to do as many of the usual active things as possible while respecting:

• pain: you can do things if the pain is bearable;
• progressiveness: don’t go jogging 3 days after your sprain, when you haven’t set foot on the ground for 3 days! You should gradually resume walking indoors, then outdoors (with or without crutches), gradually increasing distance, duration and intensity. And when it’s not too painful, and you don’t feel unstable, you can gradually resume running on flat, sandy ground.

As you’ve probably noticed, I’m a big fan of self-rehabilitation after an ankle sprain. Provided, of course, that you’re confident and can feel your way back to activity little by little!

If not, consulting a physiotherapist will probably help.

But there’s no need to feel guilty if you don’t follow the physiotherapy sessions prescribed for you because you feel you’re doing fine. Or apprehensive because you can’t get an appointment: it should be fine!

***

If you have any general questions about ankle rehabilitation, or any feedback you’d like to share, please leave a comment!

++++ Tran K, McCormack S. Exercise for the Treatment of Ankle Sprain: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Apr 3. PMID: 33074633.

Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017 Jan;51(2):113-125. doi: 10.1136/bjsports-2016-096178. Epub 2016 Oct 8. PMID: 28053200.

de Vries JS, Krips R, Sierevelt IN, Blankevoort L, van Dijk CN. Interventions for treating chronic ankle instability. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD004124. DOI: 10.1002/14651858.CD004124.pub3. Accessed 18 February 2023.

Hung YJ. Neuromuscular control and rehabilitation of the unstable ankle. World J Orthop. 2015 Jun 18;6(5):434-8. doi: 10.5312/wjo.v6.i5.434. PMID: 26085985; PMCID: PMC4458494.

Burger M, Dreyer D, Fisher RL, Foot D, O’Connor DH, Galante M, Zalgaonkir S. The effectiveness of proprioceptive and neuromuscular training compared to bracing in reducing the recurrence rate of ankle sprains in athletes: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2018;31(2):221-229. doi: 10.3233/BMR-170804. PMID: 29154263.

Pepper 2008. 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 Apr;121(4):324-331.e6