Spring is when we see it every year. Many sports start back up after winter break along the Tweed Coast, and within a few weeks our appointment book fills with the same story: “I rolled my ankle on the weekend — again.”
That word again is the important part. Ankle sprains are one of the most common injuries we treat, affecting around 8% of the general population at some point, and in high-risk sports like netball and soccer, up to 80% of people who sprain an ankle will sprain it again. Even more strikingly, research suggests that up to 70% of people who sprain their ankle go on to develop what’s called chronic ankle instability (CAI) — ongoing giving way, swelling, weakness, or a nagging sense that the ankle “isn’t quite right,” sometimes years after the original injury.
The good news is that CAI isn’t inevitable. It’s largely a rehabilitation problem, not a re-injury problem and it’s very treatable.
Why “it’s just a sprain” is the wrong way to think about it
A lateral ankle sprain happens when the ligaments on the outside of the ankle are overstretched or torn, most commonly the anterior talofibular ligament (ATFL). The swelling and bruising usually settle within one to two weeks, and by then most people feel like they can walk normally again so they go straight back to sport, assuming the injury is behind them.
Here’s the problem: pain and swelling settling down is not the same as the ankle being rehabilitated. When a ligament is damaged, so are the tiny nerve receptors inside it that tell your brain where your foot is in space: a sense called proprioception. Without deliberately retraining that system, your ankle can look and feel “healed” while still being significantly more vulnerable to rolling again, especially on uneven ground, sand, or when landing from a jump.
This is exactly why we see so many second (and third) sprains along our coastline — soft sand, footpaths, and uneven trails around Pottsville and Cabarita Beach all demand more of your ankle’s balance system than a flat gym floor does.
What the evidence says about managing the first few days
Physiotherapy has moved on from the old “RICE” advice (Rest, Ice, Compression, Elevation). Current best-practice guidance uses the framework PEACE & LOVE:
- P — Protect: avoid movements and loads that cause pain for the first 1–3 days, but don’t immobilise longer than necessary
- E — Elevate: keep the leg raised above heart height where possible
- A — Avoid anti-inflammatories: in the acute phase, some inflammation is a normal and necessary part of healing
- C — Compress: to help manage swelling
- E — Educate: understand your injury and avoid unnecessary imaging or over-treatment
- L — Load: reintroduce movement and weight-bearing as early as pain allows
- O — Optimism: confidence in recovery genuinely improves outcomes
- V — Vascularisation: gentle cardio to promote blood flow and healing
- E — Exercise: the single most important part of avoiding chronic instability
If you’re unsure whether you need an X-ray, the golden rule is the Ottawa Ankle Rules: if you can’t take four steps immediately after the injury, or there’s bony tenderness right over the ankle bones, get it checked. Otherwise, most sprains don’t need imaging they need a structured rehab plan.
The rehab that actually prevents it becoming chronic
Clinical guidelines from the Academy of Orthopaedic Physical Therapy recommend an individualised, multi-stage rehabilitation program rather than “rest until it feels better.” In practice, that means:
- Restoring range of motion early, before the ankle has a chance to stiffen up
- Progressive strengthening of the calf, peroneals (the muscles on the outside of the lower leg), and the small intrinsic foot muscles
- Balance and proprioceptive retraining — single-leg standing, progressing to unstable surfaces, then to sport-specific movements like cutting and landing
- A graded return-to-sport plan, rather than jumping straight back into a full training load
This last point matters more than most people expect. Meta-analyses of proprioceptive training programs show a significant reduction in ankle sprain recurrence when this kind of balance retraining is included, it’s not optional extra work, it’s the part of rehab that actually changes the outcome.
Signs your ankle sprain hasn’t fully healed
- It still feels unstable or “wobbly” on uneven ground
- It swells after activity, weeks or months after the original injury
- You’ve rolled it more than once
- You avoid certain surfaces (sand, trails, grass) because you don’t trust it
- You still feel the need to tape or brace it “just in case”
If any of that sounds familiar, your ankle likely needs a proper look, not more time.
When to see a physio
Book in if your sprain hasn’t settled within a couple of weeks, if you’ve sprained the same ankle more than once, or if you’re heading back into spring sport and want to make sure you’re not carrying an unrehabilitated injury into pre-season. We’ll assess your ankle’s strength, range, and balance, and build a plan specific to what you actually need, not a generic handout.