A sprained ankle occurs when the foot twists or rolls beyond its normal range of motion, damaging the tough, fibrous bands of tissue known as ligaments. Ligaments connect bones and stabilize the ankle joint. When a sprain happens, these tissues are stretched beyond their capacity, and in some cases, they are torn. The answer to whether you can continue to play on a sprained ankle is generally no, as doing so risks converting a minor injury into a long-term problem. This article explains the different levels of injury severity, the immediate care required, and the steps for a safe return to activity.
Understanding Ankle Sprains and Severity
The severity of a sprained ankle is categorized into three grades based on the extent of ligament damage. A Grade I sprain involves microscopic tearing or stretching of the ligament fibers, resulting in mild stiffness and tenderness. The ankle generally feels stable, and recovery typically takes one to three weeks.
A Grade II sprain involves a partial tear of the ligament, leading to moderate pain, swelling, and bruising. Walking is usually painful and difficult, and the joint may feel somewhat unstable.
A Grade III sprain is the most severe, representing a complete tear or rupture of the ligament. This causes intense pain, severe swelling, and significant joint instability. Recovery time ranges from three to six weeks for a Grade II injury and up to several months for a Grade III sprain. It is important to seek medical evaluation to accurately determine the grade and rule out other issues, such as a fracture.
Immediate Action: The R.I.C.E. Protocol
The initial 48 to 72 hours after an ankle sprain should focus on the R.I.C.E. protocol. Rest means stopping all activity immediately and avoiding weight on the injured ankle to prevent further injury. Using crutches or a brace can help protect the ankle during this period.
Ice should be applied for 15 to 20 minutes at a time, several times a day, to reduce swelling and numb the pain. Use a barrier like a towel between the ice pack and the skin to prevent frostbite.
Compression involves wrapping the ankle with an elastic bandage to limit swelling and provide gentle support. The wrap should be snug but not so tight that it causes tingling or numbness, which indicates poor circulation.
Elevation requires the ankle to be raised above the level of the heart as often as possible. This use of gravity encourages fluid drainage away from the injury site, reducing swelling. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may be used concurrently to manage pain and inflammation during this acute phase.
The Risks of Playing Through Pain
Ignoring a sprained ankle and continuing to play creates a high risk of worsening the original injury and causing long-term complications. Putting stress on damaged ligaments risks converting a partial tear (Grade II) into a complete rupture (Grade III), significantly increasing recovery time. This immediate re-injury makes the joint less stable and can result in chronic weakness.
A serious long-term consequence of inadequate healing is chronic ankle instability (CAI), which occurs in up to 70% of people who sustain a sprain. CAI is a condition where the ankle repeatedly “gives way” because the ligaments have not healed properly, leading to recurring sprains. The damaged ligaments fail to provide the necessary feedback for balance, making the ankle prone to re-injury.
Playing with an injured ankle also changes the way you walk or run, known as altered gait mechanics, as the body compensates for pain and instability. This compensation places abnormal stress on other joints, such as the knees or hips, potentially leading to secondary injuries. Chronic instability can also accelerate the onset of osteoarthritis in the ankle joint later in life due to improper joint function.
Roadmap to Return to Activity
A safe return to activity must be a gradual, progressive process guided by the absence of pain and the restoration of function. After the initial acute phase, the first step is to regain full range of motion in the ankle joint. Gentle exercises, such as tracing the alphabet with the big toe, help prevent stiffness and restore mobility without placing significant weight on the joint.
The next phase focuses on strengthening the muscles surrounding the ankle, beginning with isometric exercises and progressing to resistance band work, like calf raises. This strengthening provides active support to the joint, which is often weakened after a sprain. Balance and proprioception training must also be included, as the injury impairs the body’s sense of joint position.
Exercises on unstable surfaces, such as foam pads or balance boards, help retrain the ankle’s stability reflexes. Clearance for returning to sport is based on objective criteria, requiring full, pain-free range of motion and strength nearly equal to the uninjured side. The final stage involves sport-specific functional drills, such as running figure-eights or zigzag patterns, to ensure the ankle can handle the agility and stress of competition.