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The Levels of Ankle Sprains: And How To Treat!

Talk to any group of athletes long enough, and you are sure to hear their injury horror stories. For a student-athlete, the real fright comes in being sidelined indefinitely as the body has become injured or maligned in some way. Across all fields of play and levels of activity, one of the most common sports injuries remains the ankle sprain.

A sprain happens when the ligaments (those strong fibrous tissues that connect bones to other bones) become stretch passed their normative limits and are torn. You may not realize that there are varying degrees of sprains, and the severity of symptoms of each can affect your ability to return to regular activity. We spoke with Orthopedic and Sports Medicine Specialist, Dr. Burk Young, about this common concern. What can you do to prevent it, and what can you do if it happens?

**Disclaimer: with any possible injury it is best to consult a physician who can assess and grade your sprain accordingly.**

Grade 1 Sprain - Mild

A Grade 1 is defined as stretching or slight tearing of the ligament with mild tenderness, swelling, and stiffness. The ankle will still feel stable, and pain should be minimal when you attempt to walk on it.

“A grade 1 ankle sprain has an excellent prognosis,” said Dr. Young. “If treated appropriately, these should heal uneventfully without any residual sequelae. Certainly, risk factors such as smoking and diabetes could delay the healing process.”

Grade 2 Sprain - Moderate

A step further in damage to the ligament, a Grade 2 Sprain is considered a partial tear to the ligament. The ligament has also become stretched and is loose. Moderate swelling and bruising above and below the ankle joint are common

“Assessing for looseness and ankle stability can be difficult in the acute phase following any ankle sprain. This is usually due to expected pain and patient guarding. However, once the acute pain has subsided, one can determine ankle stability based on physical exam and also radiographic evaluation,” advised Dr. Young. “The anterior drawer test and also inversion stress test can be used to feel for increased laxity of the lateral ankle ligaments. This is always done along with a side to side comparison of the uninjured ankle. Also, an inversion stress x-ray can also be utilized to look for excess gapping of the ankle mortise.”

Grade 3 Sprain - Severe

The most severe of sprain, this grade is determined when the ligament has completely torn. There will be significant tenderness, and there will be swelling around the ankle, along with some bruising. Walking on this ankle will prove difficult and painful, and there should be significant instability.

“When being examined for an ankle sprain, patients can expect their physician to assess for a range of motion and also touch around the ankle to find the most tender areas involved. Also, there will likely be some gentle stressing of the ligaments to assess for stability. Also, an x-ray will usually be performed to ensure that there are no fractures involved,” stated Dr. Young. “In all likelihood, surgery will probably not be recommended in most cases. The RICE protocol Is typically the mainstay of treatment. Also, a functional stabilizing ankle brace will likely be issued or recommended.”

Sprains, no matter how mild, should not be overlooked. Repetitive sprains from activities can weaken ankles overtime and make it more likely you will re-injure the ligament again.


Most ankle sprains do not require surgery and usually can heal with care at home provided that the ankle remains immobilized appropriately. Most home treatments employ the RICE protocol: Rest (staying off it!), Ice (used in increments of 20-30 minutes, 3-4 times daily and never applied directly to skin), Compression (use of dressings, bandages and support), Elevation (keeping your ankle above your heart as much as you are able).

Much like there are three grades of sprains, there are as well three phases to treatment:

Phase 1 - rest, protecting the ankle, reducing swelling
Phase 2 - restoring range of motion, strength & flexibility
Phase 3 - maintenance exercises and gradual return to previous activities

“As a general rule, most orthopedic soft tissue injuries take around eight weeks to heal. I try to never tell patients that they ‘just have an ankle sprain.’ A more severe ankle sprain can often take almost as long to heal as an ankle fracture,” advised Dr. Young. “Milder sprains may take less than a month to heal, while the more severe sprain may often take closer to 6 to 8 weeks.

Depending on the severity of the sprain, physical therapy may be employed to help better the patient recover their previous level of strength, balance, flexibility, and activity. Your provider can adequately assess the need for therapy and help recommend therapeutic exercises for your ankle ligament.

“The ‘R’ part of the RICE protocol (rest) is the most difficult part for most people. Most people lead busy lives and find it hard to slow down and rest. Patience is an important thing to keep in mind. People tend to want to be better immediately. The good news is that most sprains will heal given proper treatment and time,” concluded Dr. Young.