Eric Tannenbaum, MD

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Ankle Sprain

Early movement and a structured rehab program lead to faster recovery after an ankle sprain than rest alone. Balance training is the most important part, because it lowers the chance of spraining the ankle again. A brace is helpful while you return to sport.

Prepared by Dr. Eric Tannenbaum, MD · Board-certified orthopedic surgeon, Southern Indiana Orthopedics

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Use this program for

  • Lateral (rolled-out) ankle sprains
  • Recurrent ankle sprains and a "weak" ankle
  • Ankle stiffness after a sprain or a period in a boot

Before you start

  • Check with Dr. Tannenbaum or your physical therapist that this program fits your condition.
  • Warm up with 5 minutes of easy movement.
  • Move slowly and with control. Quality matters more than speed.
  • Use the pain guide below to decide how hard to push.
0 to 3 out of 10Safe. Keep going.
4 to 5 out of 10Acceptable if it settles by the next morning. Otherwise ease off.
Above 5, or worse the next dayToo much. Reduce the reps, range or weight.

Phase 1: Protect and move

Days 0 to 7

Control swelling and start gentle motion.

A B C

1Ankle alphabet

  1. Sit with your leg supported and the foot free.
  2. Trace the letters of the alphabet in the air with your big toe.
  3. Move from the ankle, not the knee.

1 to 2 times through the alphabet, 2 to 3 times a day

Start right away after a sprain to keep the ankle moving.

2Towel calf stretch

  1. Sit with the leg straight and loop a towel around the ball of the foot.
  2. Gently pull the towel to bring your toes toward you.
  3. Hold the stretch in the calf.

3 repetitions, hold 30 seconds, 2 times a day

Keep the knee straight.

Phase 2: Strength and balance

Weeks 1 to 4

Rebuild strength and balance.

3Ankle band exercises (4 directions)

  1. Sit with the leg straight and a band around the foot.
  2. Push the foot down (toes away), then pull it up, in, and out against the band, changing the anchor as needed.
  3. Move slowly through each direction.

2 to 3 sets of 10 to 15 in each direction, once a day

Turning the foot outward (eversion) is the most important direction after a sprain.

4Calf raise

  1. Stand holding the back of a chair.
  2. Rise up onto your toes, then lower slowly.
  3. Progress to one leg at a time.

3 sets of 15, once a day

Take 2 to 3 seconds to lower.

5Single-leg balance

  1. Stand near a counter for safety.
  2. Lift one foot and balance on the other leg, keeping your pelvis level.
  3. Progress by closing your eyes or standing on a pillow.

3 to 5 repetitions, hold 30 seconds each leg, once a day

Keep a slight bend in the standing knee.

6Standing calf stretch

  1. Face a wall with the sore leg back and the heel down.
  2. Keep the back knee straight and lean into the wall.
  3. Hold the stretch in the calf.

3 repetitions, hold 30 seconds, 1 to 2 times a day

Repeat with the back knee slightly bent to stretch the lower calf.

Phase 3: Return to sport

Weeks 3 to 6

Prepare for running, jumping and cutting.

7Hops

  1. Once you can balance and do single-leg calf raises without pain, start with small hops in place on both feet.
  2. Progress to single-leg hops forward and side to side over a line.
  3. Land softly with the knee bent.

2 to 3 sets of 10 to 20 hops, every other day

Do these only after your balance and strength have returned, usually in the final phase.

8Side steps with a band

  1. Place a band around your ankles or just above the knees.
  2. Bend your knees slightly and stand with feet hip-width apart.
  3. Step sideways, keeping tension on the band, then step the other way.

3 sets of 10 to 15 steps each direction, once a day

Keep your toes pointing forward and your trunk still.

Avoid for now

  • Long periods of complete rest
  • Returning to sport before you can hop on the ankle without pain
  • Skipping balance training once the pain is gone

When to move ahead

Keep the ankle elevated and use compression early on. Walk as soon as you comfortably can. Continue balance exercises for at least 3 months to prevent another sprain.

Stop and call our office at (812) 376-9353 if you have

  • Pain that is getting worse week to week, or severe pain at night
  • New numbness, tingling or weakness
  • Significant swelling, redness, warmth or fever
  • A joint that locks, gives way or will not move
The research behind this program
  1. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.
  2. Martin RL, Davenport TE, Fraser JJ, et al. Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1–CPG80.
  3. Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020;54(2):72–73.

Need more help?

Work with our physical therapists

Our physical therapists at the SIO Physical Therapy & MRI building, 745 Schnier Street in Columbus, work alongside Dr. Tannenbaum and can tailor this program to you.

Request an appointmentCall (812) 376-9353

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