Is your sprained ankle still sore months later?

“Why is my sprained ankle still sore?” is probably one of the most common and frustrated questions we hear weeks after an ankle sprain.

It seems like some ankles literally bounce back while some ankles are still sore weeks and months later.

So, how long should a sprained ankle last? Should it still hurt after 3 weeks?

Why won’t your ankle pain go away?

And most importantly, what can you do about a sprained ankle that’s still sore months after it happened?

What happens when you sprain an ankle?

A “rolled ankle” happens when your ankle suddenly tilts inwards, so that the bottom of your foot is pointing towards the other foot.

As the ankle rolls inwards, the structures that form the joint and hold it together can be forced outside of their maximum tolerance.

A “sprained ankle” is basically a rolled ankle with some soft tissue injury, whether it’s a torn ligament or bony damage.

How do you know if your ankle is sprained?

A rolled ankle without a sprain usually bounces back (literally) and although there might be a sharp pain as it rolls, there’s no pain or swelling/bruising afterwards.

On the other hand, a sprained ankle is going to hurt for a period of time afterwards as the body begins the healing process and leaks fluid and irritating chemicals into the area.

The ankle might swell within an hour or so – that’s fluid leaking from a damaged or impacted structure into the space in and around the ankle.

You might even see bruising – that’s blood spreading out from ruptured tiny blood vessels (called capillaries) inside the damaged structure.

It’s usually sore to move or walk on for at least 2-3 days – that 72 hour period is due to the “acute inflammatory process” that happens after all tissue damage.

The pain is from a combination of irritating chemicals in the area, fluid getting squeezed as you put weight on it and/or from a light stretch of the damaged soft tissues while they’re still sensitive.

After that, the pain should gradually ease as the initial reaction passes. But it’s not a smooth path back to pain-free again – the pain can come and go throughout the recovery.

That’s because as it feel better, you’ll try to do more or activities you haven’t tried since the sprain, which makes it sore again.

In a normal recovery, these minor flare ups ease within a few days and the new activity becomes comfortable again.

Unfortunately that doesn’t apply to every sprained ankle…

Some of the earliest signs that your ankle pain will linger for months is that it gets sore, and stays sore, every time you try to do a little more exercise.

We’ll cover the reasons for that in the section below.

How long does it take for a sprained ankle to heal?

Let’s just focus on ligaments for the moment as we’ll cover non-ligament injuries in the section on reasons why your recovery can be delayed.)

There are some phases that the injured ligament must go through to get back to normal function (although it may never get it’s full strength back).

How do you heal a sprained ankle in 2 days?

You might have heard about people who miraculously recovered from a sprained ankle in 2 days!

So how do you make that happen? The trick is in the details…

The first phase (we mentioned it earlier in this post) is the acute inflammatory phase, which takes 48-72 hours – it’s the body’s “Oh shit!” reaction.

It’s a non-specific reaction (it’s a generic response that’s the same for any injury) that floods the area with specific chemicals and irritants.

(Research is still trying to figure out what some of the chemicals do but we think it’s the trigger to stimulate the next phase of the body’s response.)

If the actual damage to the ligament was minor or just a decent overstretch without damage, the ankle pain magically disappears after 2-3 days.

It’s nothing to do with how the ankle was managed or any special treatments, it was just a lucky rolled ankle.

So, yes, a sprained ankle can “heal” in 2 days, but that’s only because no “healing” was required.

Can a sprained ankle get better in 3 weeks?

The next phase is the clean up and delivery of materials – like in building a house, it’s when the workforce arrives with materials and readies the site for construction. It takes up to the 2 week mark post-injury.

It’s important to note that at this stage, the damaged tissue has not gained any improvement in function since the injury,

Basically your building site is tidy and has the required timber and bricks on site but you couldn’t live in it yet.

From 2 weeks to 4 weeks post-injury, the workers start to construct the walls but without any cross-bracing.

This makes the structure function OK for daily tasks but it wouldn’t stand up well to stronger forces, like uneven ground or another rolled ankle.

Most ankle sprains won’t have recovered by 3 weeks as the repair is only just starting.

However if the damage is quiet minor, called a Grade 1 ligament injury, there might be enough good ligament remaining that you can return to sport with very little additional risk.

You’d want to be certain it’s a grade 1 though – if it’s a grade 2 injury, the early return will damage the fresh repair and you might have to start your recovery all over again.

Should a sprained ankle hurt after 6 weeks?

At the 4 week mark post-injury, the cross bonds begin to form between the healing fibres. And THAT’S where the ligament gets most of its high load capacity!

It’s not just the walls and roof now, it’s the bracing between walls and under the roof that means that it’ll withstand a storm.

Remember that these cross bonds start to form from 4 weeks onwards, so you’re not bulletproof at week 4 + 1 day.

By 6 weeks after your sprained ankle, the ligament is pretty tough and the inflammatory process should have passed.

You’ll often hear that a sprained ligament takes 6 weeks to recover, and that’s where the number comes from – the healing time of a soft tissue with cross bonds.

So by 6 weeks post-injury, your ankle shouldn’t be hurting with daily activities (although you’ll still notice it at the extremes of movement.)

So why do some ankle sprains take longer to heal?

There are two main reasons why a sprain might take longer than expected to recover.

Firstly, you may have caused more widespread damage to the ankle ligaments, referred to as a Grade 3 ligament tear.

More damage needs more healing time. This is more common for first-time sprainers and isn’t a huge concern (although it can be frustrating).

The other reason is a secondary injury – this refers to an injury that is either the result to the primary or main injury, or an injury that develops in the weeks after the incident.

This is the sneaky ninja of sprained ankles! It hides under the simple, more painful ligament injury initially so you don’t notice it for a few weeks.

It can be a more subtle injury to bone or cartilage, like a bone oedema or bone bruise. Or an inflammatory reaction due to the way you’ve been limping as you return to walking. Either way, you don’t notice it until the ligament recovers.

What’s the best way to recover from a sprained ankle?

Your recovery begins the moment the injury happens (well, technically the moment immediately after it happens!)

From the old RICE acronym (Rest, Ice, Compression, Elevation), compression is by far the most important early intervention.

How long should I stay off a sprained ankle?

For the “Rest” component of the approach, this doesn’t necessarily mean complete rest or that you need to avoid putting weight on the ankle.

Do whatever you can without causing too much pain. It’s going to hurt to walk in most cases, but if you slow down and walk carefully you can get away with it.

So is it OK to walk on a sprained ankle?

If you’ve got concerns about a fracture (broken bone), you can always self-administer this testing sequence to tell you if you need an X-ray.

It’s not a bulletproof assessment and it can’t rule out a fracture entirely, but it’s pretty good at flagging a need for a medical assessment.

If you’ve still got concerns, even if the Ottawa testing was all clear, get it checked out anyway.

When can you start walking on a sprained ankle?

You can start walking on a sprained ankle as soon as it’s tolerable. It doesn’t have to be pain-free, just tolerable.

If it gets worse after a few minutes of walking, you might want to add some compression to it so that fluid pressure doesn’t build up with gravity.

If that still doesn’t help, wait another day or two and try again.

What does it mean if your ankle hurts when you walk?

The main reason why your ankle hurts when you walk in the first few days after spraining it is that fluid builds up in the area (dang gravity!) and puts pressure on the injury.

Elevating the ankle can help momentarily but it will drain straight back to the ankle soon after standing again.

If the ankle still hurts to walk on after a week, there may be some bone bruising, cartilage damage or joint reaction that causes pain with your body weight on it.

These types of injuries need to be assessed and are treated very differently.

Can walking on a sprained ankle make it worse?

Not really. Walking carefully on a sprained ankle is actually quite good for your recovery.

It provides some stimulus to the healing tissue and improves the strength of the repair.

But be warned: more is not better!

A little loading stimulates the repairing tissue, but a lot of loading will pull at it and damage the repair.

Be guided by pain and don’t push into pain or cause it to ache after activity.