Ankle Sprain Grades | How Bad Is Your Sprain?

Written by on May 4, 2022 — Medically reviewed by Mich Torres (PT)

Healthcare professionals use a graded-based system to determine the severity of your sprain. There are 3 ankle sprain grades – mild, moderate, and severe.

Matching your ankle sprain severity to a grade gives direction for the best treatments for your recovery. It can also help you estimate how long it will take you to recover.

Below, we’ll talk about each grade in detail. You’ll know how to tell which one you have and the treatments available. These are the topics we’ll cover – tap on any of them to learn more:

Grade I: Mild ankle sprains

If, after the incident, you’re experiencing minimal ankle pain and swelling, then you might have a mild sprain.

A mild ankle sprain means that your injured ligament was overstretched, with some microscopic tearing involved. Fortunately, this injury isn’t enough to affect the structural stability of your foot and ankle. (1, 2)

This means that you may still walk normally, although with a bit of pain with every step.

Overall, you may need a few days to fully recover from a mild sprain.

Common treatments for grade I ankle sprains:

Do the RICE protocol

This acronym stands for:

  • Rest. Stay away from any activities that may cause further injury.
  • Ice. Helps temporarily lower your pain sensitivity.
  • Compression. Provides comfort and is useful to reduce swelling.
  • Elevate. Also useful in dealing with pain and swelling by making gravity work for you.

Using this approach is a good way to reduce your symptoms, especially during the first 4 to 5 days after your injury. (3) It’s an accessible, effective, and widely used protocol in dealing with ankle injuries.

Learn more: Here’s how to ice your ankle the right way

Include ankle exercises in your daily routine

A few days after your injury, it’s a good idea to build back the strength and stability of your ankles. stability drills and strengthening exercises will help you with this.

A sign that you can start doing exercises is when you have close to zero pain and swelling in your ankle.

Doing this will decrease the chance of chronic ankle sprain problems down the line – like recurrent sprains and instability. (4)

Check this out: 12 Best exercises for healing an ankle sprain

Grade II: Moderate ankle sprains

Are you dealing with a decent amount of ankle pain, swelling, and bruising? Then you might have a moderate sprain.

This grade is somewhat worse than a mild sprain. Here, there’s partial tearing on your injured ligament, which can affect the stability of your ankle joint. (2)

You may be able to bear weight on your injured ankle, but you may notice a slight limp when you walk – this can be another sign of a grade II sprain.

Recovery might take place after a few weeks. RICE therapy can help initially.

Related: When can you walk with an ankle sprain?

Common treatments for grade II sprained ankle:

Apart from the grade I treatments mentioned earlier, here are other things you should do to recover:

Take some pain medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a good short-term solution for pain relief. (5) They work by reducing enzymes that produce inflammatory, pain-signaling hormones in your body.

Common over-the-counter NSAIDs are ibuprofen and mefenamic acid. This may be enough for some to help decrease pain.

If you need something stronger, it may be best to consult with your doctor first to avoid complications.

Wear an ankle brace

Your ankle joint will inevitably be vulnerable while it heals. This is because the injured ligament won’t be able to keep the usual stability of the joint – not while your body is repairing the injury.

The problem is that, during this period, the risk of re-injury is high.

But an ankle brace can provide external stability to your joint while it heals. It can help get you through your daily activities so you don’t make your sprained ankle worse.

This can be a temporary solution to make sure you heal properly, given you’re also doing other treatments, like RICE and exercise. You can use it as a supplement to physical therapy, too.

Tape your ankle

Taping your ankle is useful, especially if you want a more personalized fit than the one from a brace. There are 2 common types of tape used for sprained ankles.

First is the athletic tape. This is a rigid strip with an adhesive that sticks to your skin. Since it doesn’t stretch at all, it can provide strong external support. It’s particularly helpful if you have ankle instability.

The other is kinesiotape. This one is more flexible, you can stretch it to various degrees. This allows the tape to contour around your sprained ankle. It also helps improve your ankle awareness and function. (6)

Get physical therapy treatment

A physical therapist can help you heal better and faster.

Apart from going over treatments and rehabilitation exercises, your therapist will help you reduce your risk of severe complications – like chronic ankle instability.

Chronic ankle instability results from a poorly healed ankle.

This condition can also happen if you don’t complete your rehabilitation protocol. It can lead to symptoms like chronic ankle pain, or feeling like your ankle suddenly gives away. (4)

Your PT can help you prevent chronic ankle problems by addressing any lingering joint instability through a customized treatment plan.

Grade III: Severe sprain

Hear any popping noise as your sprain occurs? This can mean that you have a complete tear on your ankle ligaments.

If the pain is sudden and intense, it’s most likely a severe injury. Also, it can come with terrible bruising, swelling the size of a golf ball, and bony tenderness around your foot and ankle.

Due to the complete ligament tear and instability, it can be very hard to bear weight without experiencing searing pain.

A grade III sprain might take months to heal, due to the severity of the injury.

Common treatments for grade III ankle sprains:

Before anything, get your ankle checked by a doctor

As the worst type of ankle sprain, it’s highly advisable going to a doctor first. This will help rule out any fracture.

During the physical exam, your doctor may perform a series of tests to tell if you have any broken bones. After this, your physician may request further imaging tests, like an X-ray. (7)

This will help: How to tell if it’s an ankle sprain or a fracture?

A physical examination will also identify which type of ankle sprain you have.

Lateral ankle sprains will show symptoms on your outer ankle, pointing out an anterior talofibular ligament (ATFL) tear.

On the other hand, medial ankle sprains are for inner ankle symptoms of pain and swelling. For this, your deltoid ligaments are involved.

Related: What ankle sprain is the most common?

Try conservative treatments before thinking about surgery

Even with a very severe injury, surgery isn’t the first option of treatment. In fact, research shows that conservative treatments may have the same outcomes as ankle surgery in the long run. (8)

But, if such treatments fail to ease symptoms or if you also had a fracture, you may need surgery. (7)

Try this: Best home treatments for ankle sprains

For the surgical options, ankle arthroscopy tends to be the most common choice.

This is a type of minimally-invasive surgery, where your orthopedic surgeon will use a tiny camera and surgical tools to repair your injured ligament. Since it only needs a small incision, it allows for a fast recovery time.

FAQs

What is the difference between grades 1, 2, and 3 lateral ankle sprains?

The degree of ligament damage.

Grade 1 is when the ligament overstretched but didn’t tear. Grade 2 is an incomplete tear, and grade 3 sprains indicate a fully torn ligament.

Should a sprained ankle still be swollen after a week?

Depending on the severity, it can take a while before swelling resolves. Minor sprains take only a few days, while severe ones may take a few weeks.

Do grade 3 ankle sprains require surgery?

Not necessarily. Try going with physical therapy first. If it fails to deliver results, then talk to your orthopedic surgeon if you might need surgery.

Conclusion: How bad is my ankle sprain?

There are a lot of random pains and aches that can come from a sprained ankle. Knowing how to tell if it is a minor sprain to a severe one can spell the difference to a long recovery period.

Resources

  1. Hubbard, Tricia J, and Charlie A Hicks-Little. “Ankle ligament healing after an acute ankle sprain: an evidence-based approach.” Journal of athletic training vol. 43,5 (2008): 523-9. DOI: 10.4085/1062-6050-43.5.523
  2. Mugno AT, Constant D. Recurrent Ankle Sprain. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560619/
  3. van den Bekerom, Michel P J et al. “What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?.” Journal of athletic training vol. 47,4 (2012): 435-43. DOI: 10.4085/1062-6050-47.4.14
  4. Hertel, Jay, and Revay O Corbett. “An Updated Model of Chronic Ankle Instability.” Journal of athletic training vol. 54,6 (2019): 572-588. DOI: 10.4085/1062-6050-344-18
  5. van den Bekerom, Michel P J et al. “Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events.” Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA vol. 23,8 (2015): 2390-2399. DOI: 10.1007/s00167-014-2851-6
  6. Wilson, Brendan, and Andrea Bialocerkowski. “The Effects of Kinesiotape Applied to the Lateral Aspect of the Ankle: Relevance to Ankle Sprains–A Systematic Review.” PloS one vol. 10,6 e0124214. 23 Jun. 2015, DOI: 10.1371/journal.pone.0124214
  7. Al-Mohrej, Omar A, and Nader S Al-Kenani. “Acute ankle sprain: conservative or surgical approach?.” EFORT open reviews vol. 1,2 34-44. 13 Mar. 2017, DOI: 10.1302/2058-5241.1.000010
  8. McGovern, Ryan P, and RobRoy L Martin. “Managing ankle ligament sprains and tears: current opinion.” Open access journal of sports medicine vol. 7 33-42. 2 Mar. 2016, DOI: 10.2147/OAJSM.S72334

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