The Runner’s Guide to Ankle Sprains: Rehab, Recovery & Your First Run Back

Jul 3
5 min read

You’re running your favorite trail. The sun’s out, your legs feel good, and then—bam—your foot lands on a root, your ankle rolls, and suddenly you’re hobbling to the side of the path wondering what just happened.

If you've ever sprained your ankle mid-run, you're not alone. It's one of the most common running injuries out there, and it can take you out of your rhythm fast. Usually, ankle sprains go down during fast, distracted, or fatigued movement—often on uneven terrain. Trail runners are especially vulnerable, but plenty of runners have twisted an ankle stepping off a curb or tripping over a pothole. So let’s talk about what’s going on when you sprain your ankle, how serious it really is, and what it takes to get back on your feet (literally).

How an Ankle Sprain is Different From Other Injuries

It’s easy to confuse different running injuries, so let’s break down the most common types:

A sprain involves ligaments, the strong connective tissue that links bone to bone. These don’t stretch much—so when they do, it usually means a sudden force (like rolling your ankle) has pushed them beyond their limit.
A strain, on the other hand, affects muscles or tendons (which connect muscle to bone). Think of a hamstring pull or an achy calf—this kind of injury can happen either suddenly (during a sprint or hill repeat) or gradually, from too much loading without enough recovery.
Then there are overuse injuries, like plantar fasciitis, Achilles tendinopathy, or shin splints. These aren’t caused by one specific moment—they build up over time from repetitive stress. It’s your body saying, “Hey, you’re doing too much, too soon, without enough rest.”

So while all three can sideline your running, they’re not created equal. A sprain is a sudden trauma to joint stability. A strain is damage to the muscles or tendons that help you move. And overuse injuries are your tissues breaking down from accumulated load. Different causes, different tissues, different recovery paths.

Understanding Sprain Severity: Recovery & Timelines

Ankle sprains come in different severities, and that matters—a lot. The extent of the ligament damage affects everything from how your ankle feels day-to-day to how long you’ll be out of running. Here's how the grades break down, along with what to expect in terms of recovery and rehab:

Grade I – Mild

What it is: A slight overstretch of the ligament fibers, but no tearing. Think of it as your ankle saying “Whoa, that was close.”
Symptoms: Mild tenderness, slight swelling, no major bruising, and usually little to no loss of function.
Treatment: You might only need a few days of rest, ice, compression, and elevation (RICE). Light movement is encouraged early—things like ankle circles or towel scrunches help restore mobility.
Recovery timeline: Most runners are back in 1–2 weeks, depending on how the ankle responds.

Grade II – Moderate

What it is: A partial tear of the ligament. The ankle is more unstable and more painful.
Symptoms: Moderate swelling and bruising, clear discomfort when walking, some loss of range of motion and stability.
Treatment: You’ll want a more structured rehab approach here—starting with reducing swelling, followed by progressive loading, balance exercises, and strength work. A brace may be helpful during early activity.
Recovery timeline: Usually 3–6 weeks before returning to full running, depending on rehab consistency.

Grade III – Severe

What it is: A full tear of one or more ligaments. This is the "I can’t put weight on it" kind of sprain.
Symptoms: Major swelling, bruising, and clear ankle instability. It may feel like the joint could “give out.”
Treatment: This often requires crutches in the early phase, and possibly imaging to rule out a fracture. Rehab will be more intensive and closely monitored—focusing on restoring mobility first, then strength, proprioception, and gradual return to sport. Some cases may even need surgical consultation.
Recovery timeline: 8+ weeks is common. Full return to running and cutting/agility sports may take several months.

Recurrence and Prevention

Unfortunately, once you’ve sprained your ankle, you’re more likely to do it again, because ligaments, once stretched or torn, don’t heal back to their original tension or strength. Without proper rehab, the ankle can remain unstable and less responsive—especially when running on uneven surfaces or under fatigue.

The good news? With the right preventative steps, you can restore stability and dramatically reduce your risk of re-injury. Here’s how:

Strength Training - Building strength in the muscles that support the ankle—especially the calves, peroneals, and glutes—is key. These muscles help absorb shock and control movement, reducing the load on the ligaments.
Balance Drills - Ankle sprains often mess with your proprioception (your body’s sense of position). Balance work, like single-leg stands or wobble board exercises, helps retrain those stabilizing reflexes so your ankle reacts faster to unexpected movement.
Proper Footwear - Shoes that fit well and offer good support make a big difference—especially on trails. Look for trail shoes with a wide base, good tread, and lateral stability to keep your foot secure on uneven ground.
Bracing or Taping - For some runners, especially those returning from a sprain or running on technical terrain, external support can help. A lightweight ankle brace or supportive taping adds stability and can prevent re-injury when your ankle’s under stress.
Proper Fueling - It might not seem directly connected, but nutrition plays a big role in injury prevention—especially during longer or more intense runs. If you head out under-fueled or skip eating beforehand, your blood sugar can drop mid-run, leading to fatigue, poor coordination, and slower reaction time. That’s when missteps happen. Over time, consistently eating too little—what’s called low energy availability—can also weaken the tissues that support your joints, including ligaments, tendons, and even bone.

Final Thoughts

An ankle sprain might feel like a random, unlucky moment—but there’s a lot you can do to prevent the next one. Whether you’re recovering from a recent roll or trying to stay ahead of future injuries, your best defense is a strong, stable, well-trained ankle. And the next time your foot lands a little wonky mid-run, you’ll know exactly what to do.

Sources:

Encarnacion T. Ankle Sprain | UConn Musculoskeletal Institute. UCONN Health. Published November 5, 2015. https://health.uconn.edu/msi/clinical-services/orthopaedic-surgery/foot-ankle-and-podiatry/ankle-sprain/.

MacMillan C. Is It a Sprain or a Strain? How to Tell the Difference. Yale Medicine. Published January 9, 2025. https://www.yalemedicine.org/news/difference-between-sprain-and-strain.

Mugno AT, Constant D. Recurrent Ankle Sprain. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK560619/.

Sprains, Strains, and Overuse Injuries.; 2019. https://uhs.tamu.edu/docs/resources/sprains-and-strains-acha-e-brochure-texas-am-university.pdf.

Tips for Preventing Foot and Ankle Injuries. ucsfhealth.org. https://www.ucsfhealth.org/education/tips-for-preventing-foot-and-ankle-injuries.