Ankle Sprain and Chronic Ankle Instability

A sprained ankle is treated as trivial, rested until it stops hurting, and then returned to sport. That sequence is why re-injury rates are so high and why chronic instability is one of the commonest reasons an active adult stops playing.

The ligament heals with disorganised tissue and, more importantly, the position sense in the joint is disrupted. The ankle stops knowing where it is, which is a control problem rather than a strength problem.

Early controlled movement beats prolonged immobilisation 2. Balance and proprioceptive training reduces the rate of recurrent sprains, and this is one of the better-supported findings in sports rehabilitation. External support — bracing or taping — reduces recurrence during the return-to-sport period.

What is not supported: prolonged rest, routine imaging for a simple sprain, and passive modalities used alone. Ultrasound, laser and similar treatments may ease symptoms but they do not restore control, and control is what prevents the next sprain.

Inability to bear weight, bone tenderness over specific landmarks, or a high ankle injury above the joint line all change the plan and need imaging. Persistent pain beyond the expected course raises the question of an osteochondral lesion in the joint surface, which is missed regularly.

Ligament injury damages the position sense receptors within it, and that proprioceptive deficit persists after the pain and swelling have gone. The ankle then rolls again on ground that would not previously have caused it.

Balance and proprioceptive training is what interrupts that cycle, and it is the component most often skipped once walking feels normal. Exercise therapy and bracing both help prevent chronic ankle instability, so it is not an inevitable outcome of a sprain 2.

It lowers it, although it does not remove it. A 2022 meta-analysis of 14 randomised trials with 2,182 participants found that people who did exercise-based rehabilitation after an acute sprain had lower odds of having re-injured the ankle at 12 months than those given usual care 3. An overview of systematic reviews rated the evidence for preventing recurrence as moderate for neuromuscular training and strong for bracing 2. What the trials cannot yet say is which exercises are most effective or how much is enough: training volume varied widely between studies and did not change the odds of re-injury 3.

When the ankle passes a set of checks, not simply when it stops hurting. An international consensus of 155 health professionals working in elite field and court sports agreed on five areas to assess before return: pain during sport and over the previous 24 hours; ankle range of motion, strength, endurance and power; the athlete's own confidence in the ankle and psychological readiness; balance and proprioception; and sport performance, including hopping, agility, sport-specific drills and completing a full training session 4. This is expert agreement rather than trial evidence: it structures the decision, but no checklist removes the risk of another sprain entirely.