If you think you’ve sprained your ankle, the first thing to do is stop putting weight on it and start managing the swelling. Most ankle sprains heal well with home care, but some need professional evaluation to rule out a fracture or a complete ligament tear. Here’s how to handle the first hours and days, figure out how serious it is, and start recovering.
What to Do in the First 24 Hours
The approach most sports medicine professionals now recommend goes by the acronym POLICE: protection, optimal loading, ice, compression, and elevation. It’s an update to the older RICE method (rest, ice, compression, elevation), with one key difference. Instead of complete rest, which research has shown can actually weaken the injured tissue over time, POLICE emphasizes gentle, early movement as soon as you can tolerate it.
In practical terms, that means:
- Protect the ankle from further injury. Stop the activity that hurt you and avoid walking on uneven surfaces.
- Optimal loading means putting a small, controlled amount of weight on the ankle as pain allows, rather than staying completely off it for days. Even just standing briefly or taking a few careful steps counts.
- Ice for 15 to 20 minutes at a time, with a cloth between the ice and your skin. Repeat every two to three hours during the first day or two.
- Compression with an elastic bandage wrapped snugly (not tightly) around the ankle and foot. This limits swelling.
- Elevation above heart level whenever you’re sitting or lying down, which helps fluid drain away from the injury.
Pain Relief Without Slowing Healing
Over-the-counter anti-inflammatory medications are a common first instinct, but the timing matters. If you notice significant bruising right away, some physicians recommend waiting 24 to 48 hours before taking anti-inflammatories. The concern is that these medications inhibit platelets, which could increase bleeding into the injured area and worsen swelling in the acute phase.
After that initial window, anti-inflammatories can help with short-term pain control and swelling. They don’t appear to change long-term recovery outcomes, though, so use them for comfort rather than as a healing strategy. Acetaminophen is an alternative if you want pain relief without any effect on inflammation or clotting.
How to Tell if It Might Be a Fracture
Sprains and fractures can feel remarkably similar in the first few minutes. Both cause pain, swelling, and bruising. But a few signs point more strongly toward a broken bone:
- Visible deformity like a hard bump, knot, or an ankle that looks crooked
- Complete inability to bear weight immediately after the injury
- Inability to take four steps, even with a limp
- A snapping sound at the moment of injury (though ligament tears can also produce a pop)
- Numbness in the foot or toes
- Point tenderness directly over the bony bumps on either side of the ankle, especially the inner ankle bone, the back or tip of the outer ankle bone, or the heel bone
Emergency departments use a set of criteria called the Ottawa Ankle Rules to decide whether an X-ray is necessary. The rules are straightforward: if you can’t bear weight right after the injury, can’t walk four steps, or have tenderness directly over specific bones in the ankle or foot, imaging is warranted. If none of those apply, the chance of a fracture is very low. These rules were designed to avoid unnecessary X-rays, and they’ve been validated for adults and children over age five.
Mild, Moderate, and Severe Sprains
Ankle sprains are graded on a scale of 1 to 3 based on how much ligament damage has occurred. A Grade 1 sprain is a stretch or minor tear. You’ll have some pain and swelling, but you can usually still walk. These typically heal within one to two weeks.
A Grade 2 sprain involves a partial tear. Swelling is more pronounced, bruising is common, and putting weight on the ankle is painful. Walking is possible but uncomfortable, and the joint may feel unstable. Recovery takes several weeks.
A Grade 3 sprain is a complete tear of one or more ligaments. The ankle feels very unstable, swelling is significant, and bearing weight is extremely difficult or impossible. Recovery can take several months, and some cases require surgery.
Starting Rehabilitation Exercises
One of the biggest mistakes people make with ankle sprains is waiting too long to start moving. For a mild sprain, rehabilitation begins almost immediately, starting with gentle walking as tolerated. Range-of-motion exercises can also start right away, and doing them before icing the ankle (up to five times a day in the early phase) helps prevent stiffness.
A simple and effective early exercise is the ankle alphabet: sit in a chair or lie down with your foot elevated, then use your foot to slowly trace each letter of the alphabet in the air. This moves the joint through its full range without putting any load on it. Another option is the towel scrunch, where you sit with your foot on a towel on a hard floor and use your toes to scrunch the towel toward you, then push it back. Repeat 8 to 12 times. Both exercises are gentle enough for the first few days.
Stretching exercises for the Achilles tendon and calf can begin as soon as you can do them without pain. Strengthening work, like resistance band exercises, starts when you can stand without increased pain or swelling. Balance and control exercises, such as standing on the injured foot with your eyes closed, come last and are critical for preventing reinjury. Skipping this stage is one of the main reasons people sprain the same ankle again.
Bracing and Support During Recovery
Some form of external support helps during the healing process, especially for moderate sprains. You have two main options: a lace-up ankle brace or athletic tape. Most studies have found that braces are slightly more effective than taping for preventing reinjury, and they’re easier to apply yourself. Both, however, are better than no support at all.
A brace is particularly useful when you return to physical activity. Even after the pain is gone, the ligaments may still be healing, and the proprioception (your ankle’s sense of its own position) takes time to fully recover. Wearing a brace during sports or exercise for several weeks after the initial injury reduces the risk of rolling the ankle again.
What a Typical Recovery Looks Like
For a mild sprain, you’ll likely feel close to normal within a week or two. Moderate sprains take longer, often four to six weeks before you’re comfortable with full activity. Severe sprains with a complete ligament tear can require several months, and if surgery is needed, the timeline extends further.
The most important thing during recovery is to progress gradually. Pain is a useful guide: if an exercise or activity increases your pain or swelling, you’ve done too much. Back off for a day, then try again at a lower intensity. Early and consistent rehabilitation, not rest alone, is what restores strength and gets you back to normal activity faster. Progressive loading is more effective at rebuilding tissue strength than prolonged immobilization.