Whether you’re a weekend gym warrior, long distance runner or participate in team sports, you have likely heard of or experienced a lateral ankle sprain. Lateral ankle sprains are among the most common injuries affecting athletes, with studies showing that almost 75% of acute ankle injuries involve the lateral ankle ligaments with damage primarily to the anterior talo-fibular ligament.
These types of injuries also have a high reoccurrence rate in the athletic population, with the history of a lateral ankle sprain being the highest risk factor for re-injury. Athletes with repeat ankle injuries also increase their risk of developing chronic ankle instability (CAI) with some studies suggesting that up to 70% of people who experience an acute ankle sprain will develop CAI.
By understanding how lateral ankle sprains occur, how they present and how to manage them, this will allow you to decrease your risk of re-injury, prevent the development of CAI and return to play safely.

What is a Lateral Ankle Sprain?
A lateral ankle sprain occurs when the ligaments on the outside of the ankle are stretched or torn. The lateral ankle complex comprises three ligaments, the anterior talofibular ligament, the calcaneofibular ligament and the posterior talofibular ligament. These ligaments play a key roll in providing stability to the ankle joint and damage to these can significantly impact ankle function. These injuries occur when the ankle is rolled inwards (inversion), resulting in stress on the 3 ligaments supporting the ankle.
Common Causes
Sudden directional changes: Sports like rugby league, basketball, and soccer can lead to twisting motions that stress the ankle.
Sports Activities: Sports involving jumping, running and changes of direction are typically at a higher risk of ankle injuries.
Uneven Surfaces: Walking or running on uneven ground can lead to an awkward step that results in a sprain.
Previous Injuries: Individuals with a history of ankle sprains are more susceptible to re-injury due to weakened ligaments and improper healing.
Symptoms
Common symptoms of a lateral ankle sprain include:
Pain and tenderness: Localised to the outside of the ankle, but with higher grades of ligament damage there can be pain on the inside of the ankle due to bone bruising.
Swelling and bruising: This sits below the ankle joint and can run down into the outside of the foot.
Instability: A feeling of looseness in the ankle, especially during movements such as calf raises.
Limited function: This may include reduced range of motion, altered muscle activation and altered gait.
Difficulty bearing weight: Walking or putting weight on the affected leg can be painful in the first few days post injury.
Diagnosis
If you suspect that you may have torn one of the ligaments on the outside of your ankle it’s crucial to be assessed early to ensure it can be managed effectively. This will help to reduce your risk of recurrent ankle sprains and your risk of CAI. Our sports physiotherapists may use the following methods to diagnose the condition:
Physical examination: A thorough hands-on assessment, checking for tenderness, bruising and swelling, assessing ligamentous stability and assessing functional tasks such as walking, range of motion and strength.
Imaging tests: You may be referred for secondary imaging, X-rays are useful to rule out fractures which can occur with these types of injuries, and MRIs provide a detailed view of soft tissue injuries, including the lateral ligaments and any potential chondral damage.
Treatment Options
Treatment for a lateral ankle injury will vary depending on the extent of both ligament and bony damage and associated functional impairments. As per most ligamentous injuries, these are graded 1-3 and it is important to determine the extent of damage to ensure you are treated appropriately It is important to note that not all of these injuries are isolated to one ligament and that damage to multiple structures will alter rehabilitation timeframes.
Grade 1
Minor stretching of the ligaments with no major damage.
A structurally stable injury.
Grade 2
Moderate sprain with partial tearing of ligaments, resulting in more significant instability and pain
May be associated with significant swelling and both soft tissue and bone bruising.
Grade 3
Demonstrate significant instability, often patients will describe that they felt a “pop” or “crack”.
Significant swelling, bruising and functional impairments are associated.
Compared to many other ligaments where higher grades of injuries often require surgical repair, isolated ligament tears in the lateral ankle are generally conservatively managed due to the multiple ligaments that can aid to support and the potential for healing of these structures. If there is associated chondral damage or multiple ligament involvement you may be referred to an orthopaedic specialist for a secondary opinion to ensure correct management.
Rehabilitation - Conservative Management
As with all injuries, a structured rehab plan is essential for recovery and a successful return to sport. Rehabilitation is crucial with injuries to the lateral ankle due to their inherent risk of re-injury and associated development of CAI.

Here at Rehab Advantage, a lateral ankle sprain rehab will follow the following phases.
Phase 1 - Acute Repair:
Depending on the severity of your injury and associated functional impairments, you may be placed in a CAM boot and may require crutches to ensure we can protect the injured structures and aid to facilitate repair and develop good anatomical healing and scar formation.
Our main goals for this phase are:
Reduction of pain and swelling
Re-activation of the foot and calf muscles - with the added tool of electrical stimulation
Maintenance of hamstring, quadricep and hip strength
Development of single leg stance and lateral hip rotation control
Maintain energy expenditure – through off-legs conditioning
Phase 2 - Reload:
The reload phase focuses on the restoration of your gait (walking) mechanics while progressing into full body strength loading with the goal of returning to running. Your rehab program will begin to switch from bilateral (double leg) to unilateral (single leg) orientated exercises to challenge ankle stability and capacity.
Our main goals for this phase are:
Normalise gait pattern
Increase ankle range of motion
Foot and ankle strength progressions
Balance and proprioceptive exercises
Introduction of plyometric loading and run drilling
Phase 3 - Rebuild:
The main addition to this phase is the introduction of your rehab running which is done on field and supervised by one of our physiotherapists. The severity of your injury will determine the length of this phase, but you will progress through the different stages of:
Linear running
Speed and planned change of direction
Reactive change of direction and sports specific conditioning
Our rehab goals for this phase are:
Building running loads
Consolidating strength and power
Normalising plyometric profiling
Progression of sports specific skills in a controlled environment
Phase 4 and 5 - Return to Training and Sport
Our final two phases are aimed at a staged return to training, building from controlled to chaos, before a return to competition and full functional participation. Our goal during this phase is to ensure you return to your sport at a level greater than pre-injury and are ready to return to performance.
Our rehab goals for this phase are:
Progressing team training loads from controlled to chaos
Maintaining strength, power and plyometric loading
Education on ongoing resilience exercises to help prevent re-injury
Following your return to play, our physiotherapist will provide you with an ongoing ankle resilience program aimed at reducing you risk of re-injury through ongoing strength and balance training, along with education on the ongoing use of taping/bracing.
Conclusion
Lateral ankle sprain can be painful and debilitating, but early diagnosis and education around management and prevention can help you to return to play safely and decrease your risk of re-injury. If you suspect you have sustained an injury to one of the ligaments in your ankle, it is important to be assessed by a healthcare practitioner to guide you in the right direction and safely get you back to sport. Early recognition and treatment are crucial to ensure a swift recovery and a safe return back to sport without the fear of re-injury.