Not all ankle sprains and strains are created equal and, in order to access the severity of the injury and the recovery time, grading system was introduced. Injury is graded based on the force which caused it, grade 1 being the least and grade 3 being the most intense.

The Injury

This injury is fairly common, each day more than 20,000 people experience it. Most common reason is twisting and bending in the ankle beyond the “breaking point” of the ligaments. The job of the ligaments is to keep all the elements of the joint in place and they do it by stretching and expanding as we move.

But if we make any sudden movement beyond their stretching limit, they might not be able to maintain the  integrity of the joint, resulting in swelling and mild sprain. If the motion is intense enough, it can tear the ligaments and cause a grade 3 injury.

Grade 1

Ankle sprain grades depiction based on injury - illustration As I`ve already mention, ankle sprain grades 1 is the least intense injury and, typically, no tear in the ligaments occur; though, some microscopic tear in the collagen fibers may happen.

Localized swelling and tenderness may appear, but it is not severe enough to limit the range of motion or compromising the stability of the joint itself.

Treatment: immobilization and/or casting is not necessary, though your doctor will advise you to rest, keep your feet elevated and apply ice. You can also ask your physical therapist for advice on some stretching and strengthening exercises. Recovery process will typically last for 2-4 weeks.

Grade 2

Grade 2 is, obviously, a bit more serious, usually accompanied by complete tear in some collagen fibers building up your ligament, but not all, so some structural integrity is still in place. You might notice a moderate swelling and tenderness and decreased range of motion. In some cases, there is an instability in the joint as well.

Since this is a bit more severe injury, the recovery process might be a bit longer, up to 6 or even 8 weeks.

Treatment: treatment for ankle sprain grades 2 is not much different from grade 1 just expect it to last a bit longer. You will have to consult a physical therapist to devise a plan and include stretching and strengthening exercises. And since there is a complete tear in collagen fibers, your doctor might recommend immobilization, but cast is still not necessary.

Grade 3

This is the most severe case where the complete ligament is torn. It is characterized by intense pain, bruising, swelling, instability in the joint and severe impairment. Recovery process will largely depend on the intensity of the injury and the treatment: if surgery is required in order to reconstruct the damaged ligament, the patient`s recovery process may last anywhere from 12 weeks to 6 months, before full recovery.

In most cases, thought, surgery is not required but cast may be used initially (in the first 2,3 weeks) to stabilize the joint and help ligament heal properly. Physical therapy plays a crucial role in recovery and will usually last through the entire recovery process and beyond.


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