The Coach’s Guide to Ankle Sprains

I usually feel cool and confident when leading a training session. 


But at this particular moment, I felt helpless.

I turned to find one of the athletes in my class laying face up on the ground, holding her ankle.  I got there to find she sprained it when dropping down from the pull-up bar.

Being the one in charge, I wanted to help her in every way possible but felt so limited.  I assisted her to a box, fetched her a dinky first-aid ice pack, and gave her a fist bump.

As I drove home, I replayed the situation over in my head.

I decided that an elite coach needs a plan of attack for these kinds of accidents.

At the moment it may not change the outcome, but it will build confidence among those that trust you with the health and performance of their body.  You can also help equip them for a safe and speedy return to activity.

With a review of the research and consulting with a few medical professionals, I’ve put together this quick guide to ankle sprains.

Review and process for the day that you might need it.

The athletes you coach, friends, kid’s teammate, or maybe even you, will be glad that you did.

R.I.C.E Still Rules

The biggest struggle is wanting to provide a magic cure.

Unfortunately, there’s nothing that will erase this injury.  Your best bet is to get them comfortable and let them chill out.

Get them relaxed with some elevation and pressure on the injury to reduce pain and help them feel confident in you and the situation.

There is a current debate around icing or not, but, per the research, those who use ice for the first 24-48 hours return to activity faster.

10-minute intermittent ice bouts have proven better than single long-duration icing sessions.

But a ziplock with a few ice cubes, or pop and shake first-aid ice pack, seem to be worse than no ice at all. It provides zero cooling other than the skin and leaves an athlete uncomfortably sitting trying to hold it in place.

Instead, plan ahead and invest in something that works.

A big heavy cold compress around the ankle stays in place and adds some compression to the injury. Or there are also plenty of cold compression sleeves on the market, which the clinical recommendation I received is the Freeze Sleeve.

Or if you don’t have a freezer on hand, a first-aid ice pack can work but use two with some wrap to create an ice splint.

In summary, if you’re tending to someone with an ankle sprain be cool and assertive.  And remember the old acronym R.I.C.E.— rest, ice, compression, and elevation— remains the go-to.

Next Steps for Recovery

So in the short term, the best you can do is help reduce their pain and provide some reassurance in their leader.

For the long term, you can provide a lot more value.

Initially, most will want to know what they should do (i.e., Is this bad enough to need an x-ray?)

The Ottawa Ankle Rules is a simple evaluation to identify the need for an x-ray or further medical evaluation.

If they want to get a medical assessment, then you should definitely encourage that. But you can also let them know that among 1500 patients, the likelihood of an ankle fracture was 0 percent if they passed this screen.

(Image Credit:

If there’s no need for an x-ray, there are things to support the recovery process.

Start with weight bearing as much as tolerated, but consider a brace or crutches if there is a significant change in gait. For more severe sprains, a lace-up brace is helpful for the first couple weeks, especially on uneven ground  

Otherwise, get the ankle moving as soon as possible.  Use a band to stretch the ankle into plantar flexion and dorsiflexion (toes pointed down and up respectively).  Also, go through the ankle alphabet to get the muscles of the lower leg working.

Return to Activity

Current research reviews show little difference in the outcomes for those who try to push a restorative program before one-week (ref).  Yet, most athletes will want to get back to doing something as soon as possible.

For that, the following balance progression can begin as soon as weight bearing is tolerable. 

Beginning with the top exercise and working down the list, along with the stretching and ankle alphabet from the previous section.  

Complete 3-sets of 30 seconds for each exercise without a brace.  If there is pain or instability, stop at that point in the progression.

  1. Double leg balance feet together eyes open
  2. Double leg balance feet together eyes closed
  3. Tandem standing (heel to toe, foot in front of the other) eyes open, then closed
  4. Single leg balance on ground eyes open, then closed
  5. Single leg balance on an unstable surface (foam, ab-mat, pillow, etc.), eyes open then closed
  6. Single leg balance RDL
  7. Single leg balance squats with non-weight bearing leg reaching various direction
  8. Double leg squat jumps
  9. Lunge jumps (the injured side in front first)
  10. Single leg hops

Once the pain and instability have subsided for the entire progression of movements, it’s time to get back to sports specific training.  For the gym-goer, that’s not participating in multi-directional sports, get back to working out once weight-bearing but with caution.

Although after an ankle sprain, there is less proprioception and delays in firing the stabilizing muscles around the ankle.  This increases the risk of future sprains without some continued work as an athlete returns to their sport (ref).

Thus continue using the balance training program for at least 4-weeks when returning to activity to help reduce the risk of reinjury.