Sprained Ankle: Recovery Time, When You Need an X-ray, and Physiotherapy

A wrong step on an uneven Amman pavement, a bad landing in basketball, a rushed trip down the stairs — and suddenly the ankle rolls inwards and starts swelling within minutes. A sprained ankle is one of the most common injuries there is, and one of the most underestimated: people walk on it after a few days, go back to sport before it's strong, and then roll it again. This guide explains how long a sprain takes to heal, when you need an X-ray, and how to rehabilitate the ankle so it doesn't keep happening.

What is a sprained ankle?

A sprain is an injury to the ligaments — the tough bands that hold bones together and keep a joint stable. In most ankle sprains the foot rolls inwards and the ligaments on the outside of the ankle are damaged. The result is pain, swelling, bruising and difficulty walking. Sprains are usually graded from I to III depending on how badly the ligament is damaged, and the grade largely shapes how long recovery takes.

How long does a sprained ankle take to heal?

According to the NHS, most sprains feel better after about 2 weeks, but you should avoid strenuous exercise such as running for up to 8 weeks to avoid further damage, and severe sprains can take months to get back to normal. MedlinePlus notes that bruising usually fades within 2 weeks and that more severe sprains can take several weeks. Here is a rough guide by grade:

One point matters: the pain going away doesn't mean the ankle has recovered. It usually stays weaker and less stable for a while after the pain and swelling settle, and that is exactly the window in which people who rush back to sport sprain it again.

Is my ankle sprained or broken?

Sprains and fractures look and feel alike: pain, swelling and bruising in both. A fracture is more likely if you heard a crack at the time, the ankle has changed shape, the pain is over the bone itself rather than the soft tissue, or you can't stand on it at all. The only way to be sure is an examination, and sometimes an X-ray. For more, see our guide broken bone or sprain: how to tell.

Do I need an X-ray for my ankle?

Most sprains don't need an X-ray. To decide who does, doctors use the Ottawa ankle and foot rules, which UK NICE guidance recommends for people over 5 with a suspected ankle fracture. In plain language, an X-ray is usually needed if there is pain in the ankle or midfoot plus any of these:

• Bone tenderness at the back edge or tip of either ankle bone (the bony bumps on the outside or inside of the ankle).
• Bone tenderness at the base of the 5th metatarsal — the bony bump halfway along the outer edge of the foot.
• Bone tenderness over the navicular — the bony bump on the inner side of the midfoot.
• Being unable to take 4 steps both straight after the injury and when you're examined (limping still counts as a step).

The rules are designed to rule a fracture out safely, not to diagnose one, and they're applied by a clinician examining you. At Emergency Plus, X-ray is on site and urgent care sees walk-ins around the clock, so you don't have to hop between places on a swollen ankle.

When should you come in now for an ankle injury?

Call 911 for

• Bone showing through the skin, or an open wound over a deformed ankle.
• A foot that is cold, pale, blue or numb after a severe injury.
• Calf swelling or pain together with chest pain or sudden breathlessness.

Go to the ER / come in now

• You can't put weight on the foot or take more than a few steps.
• You heard a crack, or the ankle has changed shape or points at an odd angle.
• Severe, rapid swelling, or sharp pain when pressing on the bone.
• Numbness or tingling in the foot, or a wound over the injury.
• A swollen, painful, red or warm calf — possible blood clot.

Same-day urgent care

• You can walk but it clearly hurts, and you want a fracture ruled out.
• A child or teenager has hurt their ankle and is limping.
• No improvement after 5–7 days of home care, or the pain is getting worse.
• A fever, or the ankle has become red and hot.

Home care is usually fine

• You can walk, and the tenderness is over soft tissue rather than bone.
• Mild to moderate swelling and bruising that improves day by day.

What should you do in the first 48–72 hours?

The NHS advises following PRICE for the first 2 to 3 days. Many physiotherapists now add the idea of "optimal loading" (POLICE): gentle movement and gradual weight-bearing within comfort, rather than keeping the ankle completely still.

• Protect: avoid anything that could make the injury worse, and use a support or crutches if advised.
• Rest, then optimal loading: rest the ankle at first, then start moving it and putting weight through it gradually as pain allows.
• Ice: a cold pack wrapped in a cloth for up to 20 minutes every 2 to 3 hours. Don't put ice directly on the skin.
• Compression: a comfortable bandage to limit swelling — not so tight that it hurts or causes numbness.
• Elevation: raise the foot on a pillow, above the level of your heart if you can.

For the first couple of days, also avoid what's sometimes called HARM: heat (hot baths or heat packs), alcohol, running and massage — all of which can increase swelling or damage. For pain, paracetamol is safe for most people; check with a pharmacist before taking any painkiller, especially anti-inflammatories if you have stomach, kidney or heart problems or take blood thinners.

Can you walk on a sprained ankle?

With most sprains, yes — gradually. MedlinePlus advises starting to put weight on the foot after the first 48 hours, only as much as is comfortable, building up gradually to full weight, and stopping to rest if the ankle starts to hurt more. With a more severe injury, a doctor may advise partial or no weight-bearing at first. If you can't walk at all, or every step is very painful, that is a reason to get it examined and a fracture ruled out, not to push through.

What exercises help a sprained ankle?

Rehabilitation usually moves through stages. Move on when you can do the current stage comfortably, without extra pain or swelling the next day. If your injury was severe or you were told you need a brace, start exercises when your doctor or physiotherapist says it's safe.

Stage 1: Getting movement back

• Gently pointing the foot up and down while sitting.
• Tracing the letters of the alphabet in the air with your toes.
• Short walks around the house as pain allows.

Stage 2: Strength and balance

• Calf raises on both feet, then on the injured foot alone.
• Resistance band exercises to strengthen turning the foot out and in.
• Standing on the injured leg holding a counter, then without support, then eyes closed or on a cushion.

Stage 3: Getting back to sport

• Brisk walking, then light jogging on flat ground.
• Jumping on both feet, then hopping on the injured foot.
• Changes of direction, zig-zag running and drills specific to your sport.

When can you return to sport after an ankle sprain?

Return depends on what the ankle can do, not just on how many days have passed. Signs you're usually ready:

• Full or nearly full movement compared with the other ankle, with no swelling after activity.
• Single-leg calf raises on the injured side close to the number you can do on the good side.
• Steady single-leg balance, similar to the other side.
• Running, hopping and cutting without pain or hesitation.
• Confidence in the ankle during full training before you go back to matches.

Our guide to returning to sport after injury explains these stages in more detail, and applies to any sports injury, from ankles to knee pain.

Why do ankle sprains keep happening?

After a sprain, it isn't only the ligaments that are affected — your sense of where your foot is, and your balance, are often reduced too. If you go back to activity before that is restored, the ankle stays prone to rolling again, and some people end up with an ankle that keeps giving way and repeated sprains, known as chronic ankle instability. The good news: a systematic review in the Journal of Athletic Training found that completing at least 6 weeks of balance training after an acute sprain substantially reduced the risk of spraining it again. That's why single-leg balance work isn't an optional extra — it's the core of prevention.

When should you see a physiotherapist for an ankle sprain?

• The ankle hasn't clearly improved after a week or so of home care.
• It stays weak, gives way, or you keep spraining it.
• A moderate or severe sprain, or after a cast or brace comes off.
• You want to get back to sport safely without re-injuring it.
• You're still limping or avoiding stairs and uneven ground.

At the Emergency Plus physiotherapy clinic in Amman in Dabouq, the physiotherapist assesses your movement, strength, balance and walking, then builds a progressive programme around your goal, whether that's walking comfortably or getting back on the pitch. You can book directly with no referral, 9:00–20:00 daily. If anything suggests you need a doctor or an X-ray, urgent care and the emergency department are in the same building. For more, see our guide to signs you need physiotherapy.

Ankle sprains in children and teenagers

Children's and teenagers' bones are still growing, and near the ends of the bones are growth plates made of cartilage, which can be weaker than the ligaments around them. So an injury that looks like an ordinary sprain in a child or teen may actually involve the growth plate or a small fracture. A child who is limping after an ankle injury, won't stand on the foot, or is tender over the bone just above the ankle needs a medical examination, and possibly an X-ray, before starting any exercises.

Sources

• NHS — Sprains and strains
• MedlinePlus — Ankle sprain: aftercare
• NICE — Fractures (non-complex): assessment and management (NG38)
• Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis
• McKeon & Hertel — Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective? (Journal of Athletic Training)