 
 
Rehabilitation Protocol for Lateral Ankle Sprain: non-operative 
management 
  
This protocol is intended to guide clinicians through non-operative management of lateral ankle sprain. This protocol is 
time based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs 
of the individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on referring physician preference, severity of ankle instability, number of 
involved ligaments, additional impairments, and/or complications. 
  
The interventions included within this protocol are not intended to be an all-inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient, and under the discretion of the 
clinician.  
  
Diagnosis  
Considerations 
Lateral Ankle Sprain 
• Mechanism of Injury 
• Degree of ecchymosis and edema 
• Tenderness to palpation over lateral ankle ligaments 
• Anterior drawer and reverse anterior drawer test 
• Ottawa ankle rule to rule out fracture 
Differential  
Diagnosis 
• Foot and ankle fracture 
• Syndesmotic injury 
• Osteochondral lesion 
• Talar bone contusion 
• Deltoid ligament sprain 
• Peroneal tendon strain 
• Achilles tendon strain 
• Midfoot sprain 
• Epiphyseal plate injuries 
 
 
PHASE I: PROTECTION AND OPTIMAL LOADING (1-2 WEEKS AFTER INJURY) 
Rehabilitation 
Goals 
• Decrease pain 
• Decrease edema 
• Improve weight bearing 
• Protect healing structures 
Brace 
• Brace or protective tape should be worn during weight bearing activities. 
• Immobilization is recommended for 10 days for severe ankle sprain. 
Intervention 
Range of motion/Mobility 
• Foot and ankle PROM 
• Ankle pumps 
• Ankle circles 
• Ankle alphabet 
• Seated heel raises 
• Seated toe raises 
• Towel crunches/toe curls 
• BAPS board 
 
 
 
Manual therapy 
• Grades I-II to talocrural, subtalar, and mid foot for pain control 
 
Gait training 
• Normalize stance time, weight bearing, and promote heel to toe gait pattern 
 
Motor control/Balance 
• Initiate Tandem or single leg balance on firm surface if non-painful 
 
• Ice, compression, elevation, NSAIDS (if appropriate) 
Criteria to 
Progress 
• Ability to fully weight bear on involved lower extremity 
• Decreased pain 
• Minimal swelling 
 
PHASE II: INTERMEDIATE/SUB-ACUTE (3-6 WEEKS AFTER INJURY) 
Rehabilitation 
Goals 
• Decrease pain 
• Normalize gait pattern 
• Improve ankle ROM 
• Improve single leg stance stability 
• Maintain or improve proximal muscle strength 
Brace 
• Continue to wear brace for weight bearing activities. 
Additional 
Intervention 
*Continue with 
Phase I 
interventions 
Range of motion/Mobility 
• Knee to wall closed chain dorsiflexion mobilization 
• Gastroc stretch 
• Soleus stretch 
 
Manual Therapy 
• Grades I-IV to talocrural, subtalar and midfoot for pain control and mobility 
 
Strengthening 
• Resisted dorsiflexion, resisted eversion, resisted plantar flexion, resisted inversion 
• Double leg heel raises 
• Single leg heel raises 
• Standing toe raises 
• Open and closed chain knee, hip, and core strengthening 
 
Motor control/Balance 
• Tandem stance: Firm and unstable surface 
• Tandem walking 
• Single leg stance: Firm and unstable surface 
• Rocker board / Wobble board 
Criteria to 
Progress 
• Non-antalgic gait pattern 
• Equal single leg stance time and quality bilaterally 
• Full ankle PROM and AROM 
• 5/5 ankle strength with MMT 
 
PHASE III: LATE/CHRONIC (7-10 WEEKS AFTER INJURY) 
Rehabilitation 
Goals 
• Optimize strength 
• Optimize balance 
• Initiate plyometric activities 
• Initiate return to running 
Brace 
• Utilize lace up brace for functional activities as needed 
Additional 
Intervention 
Strengthening 
• Closed chain strengthening and endurance for entire lower extremity 
*Progress established strengthening exercises with increasing resistance and repetitions 
 
 
*Continue with 
Phase I-II 
Interventions  
 
Motor control/Balance 
• Single leg multidirectional reach: Firm and unstable surface 
• Dual task balance exercises: Ball toss with decreased base of support or unstable surface 
 
Plyometrics/Agility 
• Double leg hopping 
• Lateral bounding 
• Initiate agility ladder drill 
Criteria to 
Progress 
• Able to perform 25 single leg heel raises or equal number compared to uninvolved side 
• 80% or better performance on involved lower extremity compared to contralateral side with 
Star balance / Y-balance excursion test compared to uninvolved side 
• Appropriate scores on patient reported outcome measure (e.g. Cumberland Ankle Instability 
Tool or FAAM) 
 
PHASE IV: RETURN TO SPORT/FUNCTIONAL ACTIVITIES (11-16 WEEKS AFTER INJURY) 
Rehabilitation 
Goals 
• Full strength of foot and ankle 
• Improve motor control with higher level activities 
• Return to normal activities 
Additional 
Intervention 
*Continue with 
Phase I-III 
interventions 
Plyometric/Agility 
• Single leg agility drills 
• Single leg hopping  
• Change in speed and change in direction drills 
 
Return to sports/function 
• Interval sports training 
• Return to running progression 
• Compound strengthening exercises 
Criteria to 
Progress 
• 90% or better performance on involved lower extremity on Star balance / Y-Balance excursion 
test 
• 90% or better performance on involved lower extremity on single leg hop for distance, triple hop 
for distance, 6m timed hop, and/or cross over hop for distance 
• Appropriate scores on patient reported outcome measure (e.g. Cumberland Ankle Instability 
Tool or FAAM) 
• No increase in pain or swelling with plyometric and return to sports activities 
 Revised 9/2021 
 
Contact 
Please email *** with questions specific to this protocol 
References: 
 
1. 
Petersen, W., Rembitzki, I.V., Koppenburg, A.G. et al. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop 
Trauma Surg 133, 1129–1141 (2013). https://doi.org/10.1007/s00402-013-1742-5 
 
2. 
RobRoy L. Martin, PT, PhD; Todd E. Davenport, DPT; John J. Fraser, DPT, PhD; Jenna Sawdon-Bea, PT, PhD; Christopher R. Carcia, 
PT, PhD; Lindsay A. Carroll, DPT; Benjamin R. Kivlan, PT, PhD; Dominic Carreira, MD 
J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302 
 
3. 
Struijs PA, Kerkhoffs GM. Ankle sprain. BMJ Clin Evid. 2010;2010:1115. Published 2010 May 13. 
