Getting Back to Running After an Ankle Sprain: A Guide from a Physical Therapist
As a physical therapist who works with runners, one of the most common questions I hear is “When can I start running again?” after an ankle sprain. While everyone wants to get back to their training as quickly as possible, rushing back too soon can lead to re-injury or chronic ankle instability. Both of which suck and can hold you back for months, if not years. Let’s break down the recovery process and create a safe plan for return to running. This isn’t going to be a perfect guide for you to follow, but should give you a good idea of what to expect in your return process and how to speed it up. The most important part of your return is how to know when to progress, so I go into that for each phase below. Let’s dive in!
Understanding Your Ankle Sprain
First, it’s important to understand that ankle sprains come in different grades. A mild (Grade 1) sprain involves slight (but still painful) stretching of the ligaments, while a moderate (Grade 2) sprain includes partial tearing, and a severe (Grade 3) sprain means complete ligament tears. Your return-to-running timeline will vary significantly based on the severity of your injury.
To figure out the degree of your sprain, you probably need a professional. Colloquially though, a Grade 1 is often referred to as a “turned ankle” and comes with fairly minor pain. Grade 2 is a sprain that comes with more pain and swelling. Grade 1s don’t usually make a popping sound when they occur. Grade 2s usually do. Grade 1 sprains usually swell a little bit while Grade 2 usually come with a lot of swelling and some discoloration. Grade 3 sprains are gnarly and usually require surgery. If you may have that type, definitely head to your local physical therapist or orthopedist for full assessment. But if you have a Grade 1 or 2, especially Grade 1, this guide can help.
With that, on to the recovery process.
Early Recovery Phase (Days 1–7)
This process applies to all Grade 1 and some Grade 2 ankle sprains. If you have a Grade 3, you’re probably looking at a surgical repair.
During the first week after injury, follow the PRICE protocol:
Protection — Use an ankle brace or wrap during activity to prevent further injury
Rest — Avoid activities that cause pain
Ice — Apply for 15–20 minutes several times daily to reduce swelling and pain
Compression — Use an elastic bandage or compression socks to control swelling
Elevation — Keep your foot above your heart when possible to reduce swelling
You’ll know you’re ready to progress when you can walk normally without pain and significant swelling has subsided. For a Grade 2 sprain, this could take a couple of weeks, a Grade 1 will improve significantly in the first week.
Building Foundation Strength (Weeks 1–3)
Before even thinking about running, you need to rebuild your ankle’s strength and stability. This can be a long road, but here’s a good process to get you started. Start with these basic exercises:
Ankle circles: Gently rotate your foot in the air in both directions, this can help with swelling reduction if you do it while your foot is elevated
Alphabet drawings: Use your foot to “write” the alphabet in the air, gently at first, then with more vigor as time goes on
Towel scrunches: Grab a towel with your toes and scrunch it toward you to strengthen your foot and arch
Calf raises: Start with both legs with support from a counter, lean farther toward your injured side as it strengthens until you feel strong enough to do pain-free lifts just with the injured side
Balance exercises: Stand on one foot, starting with support from a counter, gradually increase duration
When you can perform all of these exercises without pain and maintain single-leg balance without any support for 30 seconds without pain, you’re ready for more dynamic movements.
Progressive Loading Phase (Weeks 3–6)
Now it’s time to introduce more running-specific movements. Your ankle needs to relearn how to handle impact and directional changes. Advance to this step once you meet the terms of the previous one. This is a slow and variable process that can include:
Walking on different surfaces (carpet, grass, pavement, uneven terrain, eventually hiking)
Heel-to-toe walking
Single leg calf raises
Side-stepping
Gentle jumping exercises
Single-leg hops (when ready)
The key here is to listen to your body. Some soreness is normal, but sharp pain means you need to back off. When you can handle single leg hops smoothly and easily and have no pain with balance or walking on any surfaces (including up hills), it’s time to move to the next phase.
Return to Running Protocol (Weeks 6–12)
Here’s where the excitement begins, but patience remains crucial. Before getting to this point, single leg hops should be smooth and easy. You should be able to do a few dozen without any irritation. You should even be able to do them up and down to a step or stool. Remember, running is basically 170 single leg hops per minute, over and over again for hours at a time. So you should be good at single leg hopping before you even get started. Once you’re comfortable with hopping and feel strong and confident, start with this progressive plan:
Week 1 of Running:
Walk 5 minutes, run 1 minute, repeat 3–5 times
Do this every other day
Continue strength exercises on non-running days
Yes, it’s boring, I know. But it’s crucial to get back to full strength
Week 2:
Walk 4 minutes, run 2 minutes, repeat 4–6 times
If pain-free, increase frequency to 3–4 times per week
Continue strength exercises on non-running days
Week 3:
Walk 3 minutes, run 3 minutes, repeat 5–7 times
Begin introducing gentle inclines if comfortable
Continue strength exercises on non-running days
Still boring, but you’re getting there!
Week 4:
Walk 2 minutes, run 4 minutes, repeat 6–8 times
Start adding direction changes on flat surfaces
Continue strength exercises on non-running days
Weeks 5–6:
Progress to continuous running, starting with 10–15 minutes on flat ground
Gradually increase duration by 10% each week
Continue strength exercises on non-running days
Introduce inclines gradually over time, up will likely be tougher on the ankle than down
Red Flags to Watch For
Stop and consult your physical therapist if you experience:
Sharp or sudden pain during activity
Significant swelling after exercise
Feeling of instability or “giving way”
New pain that persists more than 24 hours after activity
Any painful popping or clicking sensations
Long-term Considerations
Even after returning to your regular running routine, maintaining ankle strength and stability should become part of your ongoing training program. Include these elements in your routine:
Regular balance work (2–3 times weekly)
Ankle strengthening exercises
Proper warm-up including ankle mobility work
Regular shoe replacement (every 400–500 miles)
When to Consider Professional Help
While many runners can successfully return to activity following these guidelines, seeking professional help is advised if:
You’re not progressing as expected
You have a history of multiple ankle sprains
You’re training for an important event
You’re experiencing persistent pain or instability
You’re unsure about exercise form or progression
Remember that every injury is unique, and these timelines are general guidelines rather than strict rules. Some runners may progress faster, while others need more time. The key is to progress based on symptoms and function, not just time elapsed since injury.
The most successful returns to running come from respecting the healing process and rebuilding a strong foundation before jumping back into training. While it might feel like slow progress initially, this methodical approach helps prevent re-injury and sets you up for long-term running success.
By following these guidelines and listening to your body, you can return to running stronger and more resilient than before. Just remember: when in doubt, ease off the pace of progression. It’s better to take an extra week now than to risk months of recovery from a re-injury.
