The most common things that make a sprained ankle worse are putting too much weight on it too soon, skipping balance exercises during recovery, and returning to activity before the ligament has healed. About 40% of people who sprain their ankle go on to develop chronic instability within a year, and most of those cases trace back to what happened (or didn’t happen) during the recovery window.
Walking on It Too Early
After a sprain, the torn or stretched ligament fibers need time to knit back together. When you load the joint before that process is underway, you’re essentially re-stressing tissue that hasn’t regained any structural integrity. The first one to three days are critical for protecting the injury. During this window, limiting movement and keeping weight off the ankle reduces bleeding inside the joint, prevents the damaged fibers from stretching further, and gives the initial healing response a chance to take hold.
That said, prolonged rest creates its own problems. Staying completely off the ankle for too long weakens the surrounding muscles, reduces tissue quality, and slows recovery. The current clinical approach is to protect the joint for a short period, then gradually reintroduce movement guided by pain. If an activity hurts, it’s too soon. If it doesn’t, gentle use actually helps the ligament heal stronger.
Icing and Anti-Inflammatories
This one surprises most people. Ice and ibuprofen have been the default sprained ankle treatment for decades, but sports medicine guidelines have shifted. The British Journal of Sports Medicine’s current framework for soft-tissue injuries specifically recommends avoiding anti-inflammatory treatments in the early stages.
The reasoning: inflammation isn’t a malfunction. It’s the body’s repair crew. The swelling, heat, and redness you feel after a sprain reflect immune cells flooding the area to clear damaged tissue and begin rebuilding. Anti-inflammatory drugs can reduce pain and swelling in the first two weeks, but no studies have tracked whether that short-term relief comes at a cost to long-term healing. There’s simply no data beyond two weeks. Meanwhile, higher doses of these medications may interfere with the tissue repair process itself, leading to weaker collagen in the healed ligament.
Ice follows a similar logic. Despite being a universal recommendation for generations, there’s no high-quality evidence that icing soft-tissue injuries improves outcomes. Cryotherapy may blunt pain temporarily, but it can also slow the arrival of immune cells, delay the growth of new blood vessels into the injured area, and impair the maturation of new tissue fibers. Compression and elevation are safer ways to manage swelling without disrupting the healing process.
Skipping Balance and Strength Training
This is the single biggest factor that turns a one-time sprain into a recurring problem. When a ligament tears, it damages the nerve endings embedded in that tissue. Those nerve endings are responsible for proprioception, your body’s ability to sense where your ankle is in space and how it’s moving. Without that feedback loop working properly, your ankle can roll again before your muscles have time to react.
A prospective study tracking people after their first-ever ankle sprain found that those who couldn’t perform basic landing and jumping tasks within two weeks of the injury were significantly more likely to develop chronic ankle instability. Six months out, people with poor dynamic balance and lower self-reported function had greater than 80% probability of ending up with a chronically unstable ankle. These are staggering numbers, and they point to a clear pattern: the rehab you do (or don’t do) matters more than the severity of the original injury.
Balance exercises, even simple ones like standing on one foot, retrain those damaged nerve pathways. They teach the muscles around the ankle to fire quickly in response to unexpected movements. There’s strong evidence that this type of training both speeds recovery and reduces the chance of spraining the same ankle again.
Returning to Activity Too Soon
Research on professional football players found that one in four lateral ankle sprains recurred, and the majority of those re-injuries happened between two and twelve months after the original sprain. Grade 1 sprains, the mildest type, accounted for most recurrences. That’s likely because people treat mild sprains casually, resuming sports or exercise before the ligament and the surrounding neuromuscular system have fully recovered.
A sprained ankle can feel functional long before it’s actually healed. Pain fades, swelling goes down, and you can walk without limping. But the ligament is still weaker than it was, and the proprioceptive deficit described above can persist for months. Returning to cutting, pivoting, or running on uneven ground before you’ve rebuilt strength and balance is one of the most reliable ways to end up with a worse sprain than the first one.
Wearing the Wrong Shoes
Shoes play a protective role during ankle recovery by absorbing impact and stabilizing the joint during movement. Footwear that lacks ankle support, like flip-flops, ballet flats, or worn-out sneakers, removes that buffer. During rehabilitation, supportive sneakers help control the forces acting on the ankle, particularly during exercises that involve landing or shifting weight.
Interestingly, research comparing barefoot rehabilitation to shoe-based rehabilitation found that going barefoot was slightly better at reducing pain levels, while wearing sneakers produced greater strength gains in the calf muscles. Both approaches improved ankle function. The practical takeaway: during structured rehab exercises on a flat, controlled surface, barefoot training can be beneficial. But during daily life and any activity on uneven terrain, supportive shoes reduce the mechanical stress on a healing ankle.
Mistaking a High Ankle Sprain for a Regular One
Not all ankle sprains involve the same structures, and treating a more serious injury like a minor one will absolutely make things worse. The typical ankle sprain affects the ligaments on the outside of the ankle, causing swelling and tenderness below the bony bump on the outer side. A syndesmotic sprain, commonly called a high ankle sprain, damages the ligament connecting the two lower leg bones above the ankle joint.
The key differences: a high ankle sprain produces swelling and tenderness above the ankle, sometimes extending up the leg rather than down toward the foot. Pain increases when the foot is rotated outward or when the lower leg bones are squeezed together at mid-calf level. High ankle sprains require roughly twice the recovery time of even a severe lateral sprain. Treating one like a standard sprain, returning to weight-bearing and activity on a typical timeline, almost guarantees a setback.
Chronic Instability and What Drives It
Chronic ankle instability is the formal term for an ankle that keeps giving way, feels unreliable, or re-sprains repeatedly. It’s diagnosed when these symptoms persist for at least a year after the original injury, and it involves both mechanical looseness in the joint and functional deficits in the muscles and nerves that support it.
The 40% figure from prospective research is striking because it reflects people who simply let the sprain heal “naturally” without structured rehabilitation. The combination of weakened passive restraints (the ligament itself) and weakened active restraints (the muscles and reflexes that compensate for ligament damage) leaves the joint vulnerable in exactly the situations that caused the original sprain. Every factor discussed above, premature loading, inadequate balance training, early return to sport, feeds into this cycle. The ankle doesn’t just fail to heal. It adapts to instability, and that adaptation becomes progressively harder to reverse.