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Ankle Sprains

  • Writer: Dr. Doug Ashton
    Dr. Doug Ashton
  • Aug 20
  • 4 min read

Rolling an ankle is one of the most common injuries there is, and it is also one of the most under-treated. People walk it off, wait for the swelling to go down, and assume it healed. Then it turns again six months later, and the cycle starts over. If you have an ankle that keeps giving out, or one that never quite felt right after that one bad step, the problem usually is not that it failed to heal. It is that the strength and balance were never rebuilt.


What the grade of a sprain actually tells you


Sprains come in three grades, and the grade tells you how much of the ligament is involved. Knowing which one you have shapes the whole recovery.


Grade 1 ankle sprain


A grade 1 sprain is an overstretch with microscopic damage to the ligament fibers. There is mild swelling, and you can usually still bear weight. It feels minor, which is exactly why it often gets ignored and then repeated.


Grade 2 ankle sprain


A grade 2 sprain is a partial tear of the ligament, with more swelling and bruising, painful weight bearing and a feeling that the ankle is looser than it should be. This is the grade where people most often notice the ankle starting to give out on uneven ground.


Grade 3 ankle sprain


A grade 3 sprain is a complete tear of the ligament, with significant swelling, and often an ankle that cannot hold weight at all. It is the most serious of the three and needs the most structured plan to come back fully.


How physical therapy treats each grade


Physical therapy looks different at each grade, but the principle is the same. The goal is to calm the injury, restore movement, and then rebuild the strength and balance that keep the ankle stable.


For a grade 1 sprain, the work is early controlled motion, restoring strength and retraining balance so the ankle knows where it is in space. For a grade 2, we protect the healing ligament at first, then progressively load it and rebuild that same strength and balance over a longer timeline. For a grade 3, there is usually a short period of support or bracing to let the ligament knit, followed by a structured rehab program to restore motion, strength and stability before you return to sport.


What the evidence says


The evidence here is strong and current. The 2021 lateral ankle sprain clinical practice guideline from the American Physical Therapy Association supports hands-on manual therapy, therapeutic exercise and balance training, and specifically recommends against passive options like ultrasound. A 2025 meta-analysis of 10 trials and 565 patients found that physical therapy produced better pain relief than rest and standard care for grade 1 and 2 sprains. Even at the highest grade, a 2024 randomized trial in elite athletes showed that a structured therapy program restored function after a grade 3 sprain.


Why so many ankles keep rolling


What this means for you is that a sprained ankle is not something to wait out. The reason so many turn again is that the balance and strength were never rebuilt, so the ankle stays vulnerable. When the small stabilizing muscles and the sense of where the joint is in space are not retrained, the ankle keeps failing on the same uneven step. This is why we treat the whole chain, the ankle, the hip and the way you move, rather than just waiting for the swelling to pass.


Getting back to what you love


At Enhance Physical Therapy in Utah Valley, care is one-on-one, hands-on and built around finding the true source of the problem rather than chasing the symptom. If you have an ankle that keeps giving out or never quite felt right again, you can schedule a visit at https://enhancept.janeapp.com/ and we will find the source and build a plan in order to get you back to what you love.


Frequently asked questions


How long does an ankle sprain take to heal? A grade 1 sprain often settles in a couple of weeks, a grade 2 can take several weeks, and a grade 3 can take a few months to fully rehab. The timeline depends less on rest and more on how well the strength and balance are rebuilt.


Should I rest a sprained ankle or move it? For most sprains, early controlled movement beats extended rest. Current guidelines favor functional rehabilitation, hands-on therapy and balance training over sitting still and waiting.


Why does my ankle keep rolling after a sprain? Repeated rolling usually points to chronic ankle instability, which develops when the strength and balance were never restored after the first injury. Targeted rehab is what breaks the cycle.


Dr. Doug Ashton, DPT, FAAOMPT

Owner, Enhance Physical Therapy


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