Ankle Sprains: who to see and what helps

Ankle Sprains · Kitchener, Waterloo & Cambridge

An ankle sprain is a stretch or tear of the ligaments that hold the ankle joint together, most often the ones on the outside. Guidelines favour a brace or tape, walking on it as pain allows and an exercise programme over rest alone, and the exercise is also what lowers the odds of spraining it again. At CARESPACE you would see a physiotherapist or a chiropractor first, and treatment begins at that visit.

What an ankle sprain is

A sprain happens when the ligaments that support the ankle are stretched past their limit and tear. Which ligaments are hurt depends on which way the foot went:

• Lateral (outside) sprain. Most sprains are this kind. The foot rolls inward and the ligaments on the outside of the ankle are injured.
• Medial (inside) sprain. Less common. The foot turns outward and the deltoid ligament on the inside is injured.
• High ankle sprain. An injury to the ligaments that join the two lower-leg bones above the ankle. It may need surgery if the joint is unstable.

If the ankle still feels unstable or keeps giving way more than 12 months after the injury, that is chronic ankle instability. One study cited in the physiotherapy guideline followed 70 people after a first sprain, and 40% of them developed it.

Symptoms of an ankle sprain

• Pain, at rest and when you put weight on the foot
• Swelling and bruising
• Tenderness when the ankle is touched
• A feeling that the ankle is unstable or gives way

What causes an ankle sprain

The foot rolls or twists further than the ligaments allow, often on uneven ground. Around Waterloo Region it is just as often a patch of ice in a parking lot in February, or a tree root on the Walter Bean Trail. After a first sprain, the risk factors for another are playing sport, not wearing a brace and not doing balance training.

How an ankle sprain is diagnosed

The first decision is whether the ankle needs an X-ray. Clinicians use the Ottawa Ankle Rules, which the Canadian Association of Emergency Physicians endorses through Choosing Wisely Canada. As British Columbia’s guideline for adults sets them out, an ankle X-ray is needed only when there is pain around the ankle bones together with either tenderness on pressing the back edge or tip of one of those bones, or being unable to take four steps unaided, even with a limp. A foot X-ray follows the same logic for midfoot pain. Only about 15% of people who come in with an ankle or midfoot injury have a clinically significant fracture, that guideline notes.

The rules are an examination a clinician carries out, not a way to clear yourself at home. In Ontario a chiropractor can order an X-ray; otherwise one is arranged through a physician or nurse practitioner.

When an ankle injury needs urgent care

Call 911 or go to an emergency department if the foot turns pale, white, blue or grey, or feels cold to the touch, whether or not there was an injury. After an injury, do the same if you heard a crack when it happened, the leg, ankle or foot has changed shape or points at an odd angle, or it is numb, tingling or has pins and needles. Do not drive yourself.

Get medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department, if you cannot put any weight on the ankle or walk more than a few steps, the pain is very bad or getting worse, the swelling or bruising is large or still growing, the ankle is very stiff or hard to move, or you also have a high temperature or feel hot, cold or shivery, which can mean an infection.

The emergency departments in Waterloo Region are:

• WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
• WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
• Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

What the evidence says about treating an ankle sprain

• The two guidelines. A 2021 clinical practice guideline for physiotherapists and a 2018 Dutch guideline. In the physiotherapy guideline “should” is the firmer wording, used where the evidence is strong or moderate; “may” marks weaker or mixed evidence.
• Support it and walk on it. With a new sprain you should use a brace or tape and put weight on the foot progressively. If a severe sprain is immobilised, it should be for no more than 10 days.
• Exercise is the main treatment. Rehabilitation should include a structured programme of range of motion, stretching, balance and neuromuscular training, in the clinic and at home.
• Hands-on treatment goes with exercise. Manual therapy, such as lymphatic drainage and soft-tissue and joint mobilisation, should be used alongside the exercises to reduce swelling and improve movement and walking.
• What does less than people expect. There is no evidence that rest, ice, compression and elevation alone improve recovery, although repeated ice may be used. Therapeutic ultrasound should not be used. Acupuncture has conflicting evidence, and the Dutch guideline does not advise it.
• Preventing the next sprain. A brace for sport and balance-focused exercise should be prescribed after a sprain.

What a doctor may offer

None of this is done at CARESPACE, but it helps to know where it fits. A physician or nurse practitioner can arrange an X-ray, or a cast or cast-brace for a severe sprain. Anti-inflammatory medicine may be used for pain and swelling, with care, because it carries risks and may delay healing; a physician or pharmacist can say whether it suits you. Surgery is uncommon, and is considered for a high ankle sprain with an unstable joint or when instability and pain persist after months of rehabilitation.

How each CARESPACE service treats an ankle sprain

Physiotherapy

A physiotherapist can apply the Ottawa Ankle Rules, then check the swelling, how far the ankle bends, how much the joint shifts when each ligament is stressed and how well you balance on that leg. Treatment combines advice on a brace or tape and on how much to walk, mobilisation of the joint and the swollen tissue around it, and exercises that progress from movement to balance and strength.

See our physiotherapy team →

Chiropractic

Joint mobilisation and manipulation are the part of the guidelines closest to a chiropractor’s hands-on work: gentle mobilisation within pain-free movement after a new sprain, and graded mobilisation or manipulation for a long-unstable ankle. A chiropractor pairs it with brace advice and exercises, and can order an X-ray when one is called for.

See our chiropractic team →

Massage Therapy

The physiotherapy guideline’s hands-on recommendation names lymphatic drainage and soft-tissue mobilisation, on two conditions: within pain-free movement, and alongside the exercises. A Registered Massage Therapist can work on the swollen foot and ankle and the calf above it on those terms, but not straight away: the NHS advises against massage in the first couple of days.

See our massage therapy team →

Kinesiology

A kinesiologist can build the balance programme and progress it, from standing on one leg to balance boards and agility drills, and can stage the return to sport or to a job spent on your feet: activities without twisting first, cutting and turning later.

See our kinesiology team →

Other services people ask about

Acupuncture is not part of the plan described here, given the evidence above. Dry needling of the muscles on the outside of the lower leg may be used for chronic ankle instability together with balance training, on weak evidence.

Where most people start

Start with a physiotherapist or a chiropractor. Either one examines the ankle and treats it at the first visit. With any of the urgent signs above, get medical care first.

How your team works together

Your physiotherapist or chiropractor sets the plan. Massage therapy can be added while the ankle is swollen, once the first couple of days have passed, and a kinesiologist can take on the balance work for a return to sport or an ankle that keeps giving way. A straightforward sprain may need only one of them.

Browse by service: physiotherapists, chiropractors, registered massage therapists and kinesiologists.

What to expect at your first visit

1. How it happened. Which way the foot rolled, whether you could walk on it afterwards, and whether this ankle has been sprained before.
2. The X-ray check. Pressure on specific points of the ankle and foot bones, and a few steps of walking. If the rules are positive, the X-ray comes before treatment.
3. The ankle itself. Swelling, movement, each group of ligaments, and your balance.
4. Treatment, and what happens next: support, how much to walk this week, and your first exercises.

What you can do at home

The NHS advice for the first two to three days:

• Protect and rest the ankle.
• Hold an ice pack wrapped in a towel on it for up to 20 minutes every two to three hours.
• Bandage it for support during the day, and keep it raised on a pillow when you can.
• Avoid heat (hot baths and heat packs), alcohol and massage for the first couple of days.
• When the pain allows, move the ankle gently so it does not stiffen.

If the pain or your ability to put weight on it has not improved after five to seven days, have it looked at again, whether or not it was X-rayed.

How long it takes, and whether it comes back

Most sprains feel better after two weeks, strenuous exercise such as running should wait for up to eight weeks, and severe sprains can take months, according to the NHS. Some linger: in the studies behind the physiotherapy guideline, 5% to 33% of people still had pain a year or more later. Incomplete rehabilitation is the most common cause of chronic instability, which is the argument for finishing the balance work after the pain has gone.

Ankle sprain treatment in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener, Chiropractor in Kitchener, Massage Therapy in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Physiotherapy in Waterloo, Chiropractor in Waterloo, Massage Therapy in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Locations: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How do I know if my ankle is sprained or broken?

Often you cannot tell, because a severe sprain and a break produce similar symptoms. A clinician uses the Ottawa Ankle Rules to decide whether an X-ray is needed. A crack at the time of injury, or an ankle that has changed shape, means an emergency department.

What kind of ankle brace, and for how long?

A lace-up or semi-rigid brace is preferred to an elastic bandage, for four to six weeks, in the Dutch guideline. CARESPACE supplies ankle braces and tape.

Should I walk on a sprained ankle?

Yes, as pain allows, once the Ottawa Ankle Rules or an X-ray have settled the question of a fracture. Rest alone is not the treatment.

Why does my ankle keep giving way, and what helps?

Usually because of the chronic instability described above. Balance and neuromuscular exercise should be prescribed, with joint mobilisation or manipulation for short-term gains in ankle bend and balance. A brace or tape should not be the only treatment.

Where can I get a sprained ankle treated in Cambridge?

Physiotherapy is offered in Cambridge, where our location is on Hespeler Road, and a physiotherapist assesses and treats at the first visit. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening. For the emergency signs above, the Cambridge emergency department is at Cambridge Memorial Hospital.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• Martin RL, Davenport TE, Fraser JJ, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. Clinical practice guideline, Journal of Orthopaedic & Sports Physical Therapy, 2021.
• Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine, 2018.
• BC Guidelines (Guidelines and Protocols Advisory Committee, British Columbia). Ankle Injury: X-Ray for Acute Injury of the Ankle or Mid-Foot. Effective 2014.
• Canadian Association of Emergency Physicians. Emergency Medicine: Ten Tests and Treatments to Question. Choosing Wisely Canada, updated 2024.
• NHS. Sprains and strains. Reviewed 2024.
• College of Chiropractors of Ontario. Standard of Practice S-006: Ordering, Taking and Interpreting Radiographs. Amended 2023.
• American Academy of Orthopaedic Surgeons. Sprained Ankle. OrthoInfo.
• MyHealth Alberta. Foot Pain: Care Instructions. Current as of July 2024.

Related conditions

Achilles Tendinopathy
Stress Fractures
Plantar Fasciitis

Ready to book?

Book online with a physiotherapist or chiropractor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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