Roll your ankle on the weekend? The difference between a quick recovery and months of repeat niggles may not just be how bad the sprain was — it may actually be what happens next.
How should you manage this injury?
Who should you see? What should you do within the first few weeks?
1) Immediately Post Injury
The commonly known RICER acronym — Rest, Ice, Compression, Elevation, Referral — has long been a mainstay in acute injury care. While there have been some recent adaptations to the acute injury management principles, they still remain relevant. It is important to have your ankle assessed by a relevant medical practitioner or physiotherapist to assist with early management of your sprain.
RICER – First Few Days After Injury
R – Rest Limit movement or loading that increases pain during the first 1–3 days. This might mean using crutches or a brace for short-term offloading — but avoid total rest when possible. Short-term immobilisation may be appropriate for severe pain or swelling, but transitioning to functional rehab as soon as possible is essential. These decisions will be made collaboratively between you and your health practitioner.
I – Ice Use ice for short-term pain relief (e.g., 15–20 minutes on, 20–30 minutes off), but avoid overuse as cold can impair inflammation and may delay tissue repair.
C – Compress Apply an elastic bandage or sleeve to reduce swelling while maintaining comfort and circulation.
E – Elevate Raise the ankle above heart level as often as possible (ideally several times a day for 15–30 minutes), especially in the first 48–72 hours, to help minimize swelling .
R – Referral This is where we come in. Our physiotherapists are here to diagnose your injury, educate you about it, and guide you through recovery. Gentle movement and progressive loading may start earlier than you think — within pain limits — to help tissues remodel and maintain strength.
2) What else should you avoid the first few days?
• Alcohol - Avoid alcohol for the first 2-3 days post injury. This may open up your blood vessels and cause more pain and unnecessary swelling. This could also delay healing.
• Avoid - Anti-inflammatories - In the very acute stage, these may interfere with the body’s natural inflammatory process, which is important for healing. Seek medication advice from your medical doctor or pharmacist.
3) Should You Get an X-Ray?
Having your ankle assessed by a medical professional, physiotherapist, or relevant qualified practitioner should be your first step.
The Ottawa Ankle Rules (OAR) help screen for potential fracture. These rules are highly sensitive for ruling out fractures in acute ankle injuries in adults, meaning they’re a reliable way to avoid unnecessary X-rays while catching those that need them (Beckenkamp et al., 2022; Stiell et al., 2003).
Why this matters: Quick and accurate triage prevents delays in starting the right rehab plan.
4) What Else Can Your Physiotherapist Do to Help?
• Ankle hands on therapy – Our Physio can provide hands on therapy including taping for support, mobilisation techniques to help restore range and more.
• Soft tissue techniques – can assist with pain relief, reduce stiffness, and support regaining muscle function post-sprain.
• Exercise prescription – Targeted rehab exercises restore range of motion, strength, balance, and sport-specific skills. They also reduce the risk of future sprains.
5) Red Flags: Seek Immediate Physiotherapist or Medical Review If…
• You can’t walk more than a few steps after several days
• You have numbness, tingling, or colour changes in the foot
• Significant aching pain at night in injured area
The Bottom Line
Most ankle sprains recover well with early movement, functional treatment, and progressive loading guided by a physiotherapist — but poor management in the first few weeks is a key reason they become recurring problems.
If you’re unsure how to safely progress or manage your injury, our physio team can assess your ankle, guide your rehab, and make sure you get back to sport or daily life with confidence and stability. Physiotherapists at BODYSYSTEM are proficient in managing ankle sprains, both sporting and non-sporting related.
If you’ve had an injury over the weekend, please download our information guide.
References Beckenkamp PR, Lin CWC, Macaskill P, et al. (2022). Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: systematic review & meta-analysis. BMC Musculoskelet Disord. Stiell IG, Greenberg GH, McKnight RD, et al. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. Kerkhoffs GMMJ, Rowe BH, Assendelft WJJ, et al. (2002). Immobilisation vs functional treatment for acute lateral ankle ligament injuries. Cochrane Database Syst Rev. Martin RL, Davenport TE, Fraser JJ, et al. (2021). Ankle stability and movement coordination impairments: lateral ankle ligament sprains – Clinical Practice Guideline (Revision 2021). JOSPT. Bleakley CM, Taylor JB, Dischiavi SL, Doherty C, Delahunt E. (2022). Exercise-based rehabilitation reduces re-injury following acute lateral ankle sprain: systematic review & meta-analysis. PLOS ONE. Weerasekara I, Deam H, Bamborough N, et al. (2019). Mobilisation with movement in lateral ankle sprain: systematic review & meta-analysis. Foot (Edinb). Smith MD, Vicenzino B, Bahr R, et al. (2021). Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—international consensus. Br J Sports Med.
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