You’ve just sprained your ankle. What should you do? How long should you ice? How much time should you take off?

Ankle sprains are very common injuries. They occur when the foot rolls inward after stepping on an uneven surface, which damages the ligaments on the outside of the ankle.

Ankle sprains are graded on a scale of one to three. Grade one means you’ve simply stretched or microscopically injured the ankle ligaments. Grade two means you’ve partly torn the ligaments, resulting in more swelling and stretching. Grade three, the most severe sprain, means the ligaments have torn completely, possibly even off the bone.

It’s never normal to have continuous joint pain accompanied by swelling, but don’t judge your ankle sprain’s seriousness by the amount of swelling. Some people have a fair amount of swelling but may have simply torn or broken a blood vessel or torn more scar tissue. Conversely, some of the most severe ankle sprains have more swelling in the foot and toes because the ankle ligaments and joint capsules are completely torn and the fluid essentially rolls downhill toward the toes.

One of the best indicators of the severity of an ankle sprain is the ability to put weight on the foot and to move the foot. If you are unable to put weight on an ankle sprain for at least a day, you should go see your doctor and get an X-ray to rule out a fracture.

Generally, a grade two sprain means you’ll need to take two to seven days off from participating in athletic activity. Grade three ankle sprains often require a cast for three to six weeks. Though grade three sprains are the least common, they can occur if you ignore repetitive grade one and grade two sprains.

Initial Treatment

Immediately after an ankle sprain the ankle should be Rested, Iced Compressed and ; Elevated (RICE).

1. Apply ice on the ankle for 30 minutes, then remove the ice for 30 minutes. Never use a chemical ice pack (“blue ice”) because it can freeze the skin. Continue icing for 24 to 72 hours.
2. To reduce swelling, compress the foot and ankle by wrapping with an Ace bandage.
3. While resting, elevate your ankle above your heart.

Follow-up Treatment

A good physical therapist can show you several exercises and other treatments. You should be able to perform these without pain at least three times a day.

If you don’t have access to physical therapy or a trainer, try these range-of-motion exercises.

1. Gently tip your toes up and down.
2. Use the big toe to “draw” the alphabet.
3. Extend your leg and place a towel or rubber tubing around the ball of your foot. Holding the towel or tubing, flex your foot toward you and then away from you.
4. While seated, place your foot on a towel and curl your toes and foot to grip the towel.
5. Place rubber tubing around a table leg and around the ball of your foot. While seated on the floor with your leg extended, flex your foot toward you, using the tubing for resistance.
6. Walk a few steps on your heels only, then on your toes only.
7. Try to balance on the sprained ankle like a stork. If you’re able to do this for more than 15 seconds, then gradually stretch out your arms and other leg and wave them around to challenge your sense of balance.

In addition to range-of-motion exercises:

• Check with your doctor about taking anti-inflammatory medications (Advil, Aleve or a prescription anti-inflammatory) to reduce pain.
• Put weight on the ankle as the pain allows. Sometimes a walking boot or crutches may help. Often, an air-cast is used after the walking boot is discontinued. Use a functional ankle brace to transition back to sports.
• If you have wobbly ankles or high arched feet, you may benefit from orthotic devices.
• Keep in touch with your doctor. Less commonly, surgery is required to repair or even reconstruct ankle ligaments because of joint-damaging sprains.