Sprained Ankle: When to Rest, When to Rehab, When to See a Physical Therapist
If you've ever rolled your ankle during a trail run in Powell Butte or landed awkwardly after a jump shot at the local rec center, you know that sinking feeling when you realize something's wrong. One moment you're moving confidently, the next you're hobbling and wondering how long you'll be sidelined. As a physical therapist here in Happy Valley, I see patients with ankle sprains every week—from weekend warriors to competitive athletes—and the good news is that with the right approach, most people can get back to their activities stronger than before.
In this guide, you'll learn exactly when to rest your sprained ankle, when it's safe to start moving again, and most importantly, when it's time to seek professional help. I'll walk you through proven exercises you can do at home, share the warning signs that shouldn't be ignored, and explain how physical therapy can not only speed your recovery but help prevent future injuries. Whether you're dealing with your first ankle sprain or you're someone who seems to roll their ankle every few months, this information will help you make informed decisions about your recovery.
What Is a Sprained Ankle?
A sprained ankle occurs when the ligaments that stabilize your ankle joint are stretched or stressed beyond their normal capacity. Ligaments are tough bands of tissue that connect bone to bone and help stabilize joints, think of them as strong rubber bands, when they're overstretched, they can develop small tears or, in severe cases, rupture completely.
Most ankle sprains happen when your foot turns inward while your body's weight and momentum carry you forward, causing the ligaments on the outside of your ankle to stretch or tear. Common symptoms include:
Pain and tenderness, especially around the ankle bone
Swelling that may extend into your foot
Bruising that can appear hours or days after the injury
Limited range of motion when trying to move your ankle
Instability or feeling like your ankle might "give way"
Difficulty bearing weight on the affected foot
Ankle sprains are graded from I to III based on severity:
Grade I (Mild): Ligament is overstretched. Typical healing time: 7-14 days with minimal activity limitation
Grade II (Moderate): Partial ligament tear. Typical healing time: 2-6 weeks with gradual return to activity
Grade III (Severe): Complete ligament tear. Typical healing time: 6-12 weeks and may require surgical consultation
Why Ankle Sprains Happen: Common Triggers
Understanding how ankle sprains occur can help you prevent them in the future. Most happen during activities that involve:
Uneven surfaces: Hiking trails, basketball courts, or even stepping off a curb wrong can catch your ankle off guard. Oregon's beautiful outdoor terrain—from rocky trails to root-covered paths—requires constant ankle adjustments that can sometimes exceed your ankle's capacity.
Quick direction changes: Sports like basketball, soccer, and tennis demand rapid cuts and pivots that can overwhelm your ankle's stability systems, especially when you're fatigued or not properly warmed up.
Landing mechanics: Jumping and landing activities put significant stress on your ankles. Poor landing technique or unexpected obstacles can cause your foot to land in a compromised position.
Previous injury history: If you've sprained an ankle before and didn't complete proper rehabilitation, you're at higher risk for re-injury. This is why so many people become "chronic ankle sprainers" the initial injury was never fully rehabbed back to normal..
Muscle weakness or fatigue: When the muscles that support your ankle become tired or weak, they can't provide adequate protection during challenging movements.
What You Can Do at Home: The PEACE and LOVE Protocol
For the first 24-72 hours after your ankle sprain, follow the PEACE protocol:
P - Protect: Avoid activities that increase pain. Use crutches if needed to avoid putting weight through the ankle.
E - Elevate: Keep your ankle elevated above heart level when resting to reduce swelling.
A - Avoid anti-inflammatories: Let your body's natural healing process work. Ice can be used for pain relief but isn't necessary for healing.
C - Compress: Use an elastic bandage or compression sleeve to provide support and limit swelling.
E - Educate: Understand that your body is designed to heal. Avoid aggressive treatments that might interfere with recovery.
After the initial 72 hours, transition to the LOVE protocol:
L - Load: Gradually return to normal activities as pain allows. Movement promotes healing.
O - Optimism: Maintain a positive outlook. Your mindset affects recovery.
V - Vascularization: Engage in pain-free cardiovascular exercise to promote blood flow.
E - Exercise: Begin appropriate exercises to restore strength and mobility.
Early Movement Exercises (start these 2-3 days after injury, if tolerable):
Ankle pumps: While sitting or lying down, slowly point your toes up and down. This helps reduce swelling and maintains mobility. Can do with floss band around ankle
Alphabet exercise: Use your big toe to "write" the alphabet in the air, moving only from your ankle.
Towel scrunches: Place a towel on the floor and use your toes to scrunch it toward you, working the small muscles of your foot.
Important: Only do exercises that don't significantly increase pain. Some discomfort is normal, but sharp or severe pain means you should stop.
When to Seek Professional Help: Red Flag Warning Signs
While many ankle sprains can be managed at home initially, certain signs indicate you need professional evaluation:
Seek immediate medical attention if you experience:
Inability to bear any weight on the ankle immediately after injury
Severe deformity or obvious bone displacement
Numbness or tingling in your foot
Signs of infection (fever, red streaking, warmth)
Complete inability to move your ankle
Consider seeing a physical therapist if:
You're still experiencing significant pain after 3-5 days
Swelling isn't decreasing after the first week
You feel unstable or like your ankle might give way when walking
You've had multiple ankle sprains in the past
You're not progressing with home exercises after 1-2 weeks
You want to prevent future injuries and optimize your recovery
Remember, seeking professional help doesn't mean you failed at self-care—it means you're taking a proactive approach to ensure the best possible outcome.
Professional Physical Therapy Treatment Options
At Timber and Iron Physical Therapy, we take a comprehensive approach to ankle sprain rehabilitation that goes beyond just treating the immediate injury.
Manual Therapy: We use hands-on techniques to restore normal joint mobility and reduce muscle tension. This might include gentle joint mobilizations to improve ankle range of motion and soft tissue work like myofascial decompression (cupping), massage, or instrument assisted soft tissue mobilization (IASTM)to address any movement restrictions that developed during your injury.
Progressive Exercise Prescription: We design a customized program that progresses from basic range of motion to sport-specific movements. This includes strength training for the muscles that support your ankle, balance and proprioception exercises to retrain your body's position awareness, and plyometric training for athletes returning to jumping and cutting sports.
Movement Analysis: We evaluate how you walk, run, or perform your specific activities to identify any movement patterns that might have contributed to your injury or could lead to re-injury.
Functional Training: Rather than just getting you back to "normal," we work to make you more resilient. This includes teaching proper landing mechanics, improving hip and core stability that supports ankle function, and developing strategies for managing uneven terrain.
I work with everyone from trail runners preparing for their next Mount Hood adventure to parents who just need to chase their kids around without worry. Our goal is always to not just get you back to your activities, but to help you return with greater confidence and reduced injury risk.
Frequently Asked Questions
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Recovery time varies significantly based on the severity of the sprain and your individual healing factors. Grade I sprains typically heal in 7-14 days, Grade II sprains take 2-6 weeks, and Grade III sprains require 6-12 weeks or longer. However, returning to full activity—especially sports—often takes longer than when the pain goes away. Proper rehabilitation is key to preventing re-injury.
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This depends on the severity of your injury. There are situations where the ankle can be broken and it's still possible to put weight on it. If you can bear weight without significant pain increase, gentle walking is often beneficial for healing. However, if walking causes severe pain or you feel unstable, use crutches until you can walk more comfortably. The key is listening to your body and not pushing through severe pain.
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For the first 24-48 hours, ice can help with pain relief, but it's not essential for healing. After the initial period, heat may feel better and can help with mobility. The most important thing is gentle movement as soon as you can tolerate it.
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With proper rehabilitation, most people return to full function without long-term problems. However, research shows that people who don't complete adequate rehabilitation have higher rates of re-injury and may develop chronic ankle instability. This is why working with a physical therapist can be so valuable—we ensure your ankle is truly ready for your activities.
Take the Next Step in Your Recovery
Recovering from an ankle sprain doesn't have to mean months of uncertainty or worry about re-injury. With the right approach—combining appropriate rest, progressive movement, and professional guidance when needed—you can return to your favorite activities with confidence.
The key takeaway: Most ankle sprains heal well with proper early care and gradual return to activity, but don't ignore warning signs that indicate you need professional help. Grade I sprains typically resolve in 1-2 weeks, while more severe injuries may take 2-3 months for full recovery.
If you're dealing with an ankle sprain that isn't improving as expected, or if you want to ensure you're doing everything possible to prevent future injuries, we'd love to help. Ready to take control of your recovery? Schedule a consultation today, and let's create a plan to get you back to the activities you love—stronger and more confident than before.