Stiff Ankle After Sprain

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Why does the ankle become stiff after a sprain?

The inflammatory phase of healing, which is a normal and necessary part of the healing process, happens in the days to weeks following in ankle sprain or other ankle injury. In very simple terms, the inflammatory phase of healing will provide a clean slate for tissue repair after an ankle injury.

While this is a normal part of the healing process, it can still be quite uncomfortable and may even cause severe ankle pain. Swelling also often occurs after an ankle sprain, and moving the injured ankle may be painful. This is one of the reasons you can end up with a stiff ankle after a sprain, especially if the inflammation phase is excessive or prolonged.

A doctor may recommend anti-inflammatory medications immediately after an ankle sprain to try and improve comfort in the immediate days to weeks following the injury, but this should be discussed with the doctor or pharmacist first to ensure these form of medications are safe for you.

Additionally, if physical therapy exercises are not performed at any point in the recovery process, the tissue around the ankle (e.g. muscles, tendons, ligaments, joint capsule, etc) may adapt to less movement, thus becoming stiffer. A physical therapist will be able to measure and track your ankle range of motion to ensure it is being properly restored after an injury.

Is it safe to stretch after an ankle sprain?

Stretching after an ankle sprain can help reduce stiffness, but only when there is no risk of further damaging involved structures.

For example, stretching the ankle into an inverted position immediately following an inversion ankle sprain is typically avoided, as stretching the injured ligament will disrupt its healing. However, once the injured ankle ligaments are healed, then it may be appropriate to progressively regain this range of motion.

We will discuss the general process reducing ankle stiffness after an a sprain in sections below. This is not a one-size-fits-all approach, and as such, is highly recommended to be guided by a physical therapist, but we’re hoping this provides a general idea of what to expect.

What are some ways to reduce ankle stiffness after a sprain?

One of the key concepts to for improving ankle range of motion is to utilize rehabilitation exercises in a very progressive manner, especially if this is following an acute ankle sprain.

This will help ensure that you don’t over-do it and cause unnecessary pain, and will also help maintain an optimal environment for healing.

The following are some strategies and associated rehabilitation exercises that many people use to help address a stiff ankle after a sprain:

Active Range of Motion (AROM)

Active range of motion, which is usually abbreviated as “AROM”, is just what it sounds like and is one of the most common rehabilitation exercises to perform for a sprained ankle. In this case, the ankle is being moved actively under your own power, as opposed to something like a passive calf stretch.

Active range of motion exercises can take many forms depending on the severity of injury and how far along in the healing process you are. In the early stages, this may be limited to small motions within a pain-free limit to allow the sprained ankle to continue healing, and in the later stages may involve working harder to push the range of motion as far as you can.

Ankle Active Range of Motion and Early Proprioception Exercise Example

One of the most common early active range of motion exercises for a sprained ankle is tracing the alphabet with your foot by only moving the ankle. This is usually done within tolerance, meaning you are avoiding moving the ankle into positions that cause pain. Tracing the alphabet will combine all movements of the ankle, which consists of ankle dorsiflexion, plantarflexion, inversion, and eversion.

– Rest your ankle comfortably on the floor, or if you are on a couch or in bed, sit with your legs out in front of you.

– Visualize the letters of the alphabet and trace the letters of the alphabet by moving your foot and ankle, but not the knee or hip.

– Visualizing and tracing these letters, rather than moving your foot and ankle randomly without watching it, is quite important as you are also working on a special type of sensation called proprioception. Proprioception is basically joint position awareness and really feeds into balance and stability. If you slip and automatically catch yourself from falling or rolling your ankle, this is proprioception at work.

– It is very important to emphasize lower body proprioception when rehabbing an ankle sprain, and this alphabet exercise is one of the earliest and most basic ways to get started, especially when weight bearing is difficult.

Another Ankle Active Range of Motion Exercise Example

– Another pure AROM exercise that can be done throughout the day for a sprained ankle simply involves moving the ankle up and down (plantarflexion and dorsiflexion), which will help contract and stretch the calf muscle.

Figure 1. Example of someone performing ankle plantarflexion active range of motion on the left ankle.

– This is important to not only minimize the development of calf stiffness as much as possible, but will also help to minimize the risk of developing a deep vein thrombosis (DVT), which is the formation of blood clots in the calf that happen when the ankle is not being used. Blood clots can be deadly, so it’s highly recommended to take the prevention of blood clot formation seriously (Prince III et al, 2018).

*** Signs of a DVT can include sudden swelling, redness, and pain in the calf/lower leg and is different from the pain initially experienced with an ankle sprain. If you suspect you have a DVT, this must be urgently addressed with an immediate visit to the emergency room.

Active-Assisted Range of Motion (AAROM)

Active-assisted range of motion means that you are actively moving your ankle joint, but getting a little assistance along the way. AAROM can be used in different scenarios. If the ankle is severely sprained to the point where it hurts to actively move it, but is safe to move it, performing AAROM may be a much more comfortable way to get started with range of motion exercises.

In the later stages of recovery, range of motion exercises may be performed in a more intense fashion, whereby you are actively moving the ankle and using assistance to provide overpressure into the movements you are working on, so it’s basically combining active movement with a passive stretch to get as much out of the ankle as possible.

Ankle Active-Assisted ROM Exercise Example

– Consider the case of trying to improve ankle dorsiflexion range of motion.

– Sit in chair with your leg straightened out in front of you.

– Place a belt around your midfoot or forefoot foot and hold the other end in your hand.

– Actively lift your foot up towards you while keeping your heel on the ground.

– Use the belt to help pull your foot upwards at the same time that you are actively performing this motion.

– You may pause or hold the dorsiflexed position for a few seconds, but usually, AAROM exercises will involve moving the ankle joint in and out of this position repeatedly (for example, 3 sets of 15 repetitions).

Figure 2. Example of someone using a resistance band to assist with active ankle dorsiflexion

Passive Range of Motion

Passive range of motion exercises, abbreviated as “PROM”, can also be performed at various points in the recovery process depending on the phase of healing and sensitivity of the ankle. In this case, the muscles around the ankle remained relax and your ankle is being guided through movement by external forces.

Ankle Passive Range of Motion Exercise Example

– Sit in a chair and place your foot flat on the ground.

– Make sure your foot is able to slide on the surface. This may simply involve wearing a sock and being on a hardwood floor, or you may have to put something under your foot to allow it to slide on whatever surface you are on.

– Push your foot away from you by straightening your knee, and then pull it back towards you by bending your knee, all while keeping your foot flat on the floor. This will work on ankle joint plantarflexion and dorsiflexion, respectively, and does not require you to actively use the ankle muscles.


Stretching exercises are usually reserved for the mid-to-late stages of ankle sprain rehab, as it tends to be one of the most aggressive ways to reduce ankle stiffness after a sprain.

In this case, you would passively place the ankle into a position where the structures being targeted are on stretch, and then holding that stretch position for some time, usually in the neighbourhood of 30 seconds.

One of the most common muscle groups that requires stretching after an ankle sprain are the calf muscles. There are two main muscles to worry about in this case: the gastrocnemius muscle and the soleus muscle.

These muscles combine to form the Achilles tendon and insert on the back of the heel. The gastrocnemeus crosses both the knee and the ankle, whereas the soleus only cross the ankle, and as such, they can each be separately targeted by placing the ankle and knee in certain positions.

Calf Muscle Stretch Example

– Stand in front of a wall and stagger your stance by placing the injured ankle behind you and the healthy ankle in front of you.

– Lean forwards into a wall keeping your back heel on the ground.

– As you lean forwards, this will place your ankle in a dorsiflexed position, thus stretching the calf muscle. You should begin to feel a stretching or pulling sensation on the back of your leg and ankle.

– To target the gastrocnemius, ensure that you keep your knee straight while holing this position.

– To target the soleus, bend the knee slightly without lifting your heel. You may feel the stretching sensation shift a little lower down in the back of the leg or ankle.

– Stretching should not be painful. A comfortable stretching sensation that can be held for approximately 30 seconds is often recommended, but this can be guided by your physical therapist.

– To see better results, it’s usually recommended to perform stretching more frequently, for example, 3 reps 3 times per day, rather than one big long hold.

Figure 3. Example of someone performing a calf stretch with a focus on the left gastrocnemius muscle.


Performing strengthening exercises for the muscle around the foot and ankle may seem to be a counter-intuitive approach to reducing ankle stiffness after a sprain, but it can help with this for two main reasons.

First, it can help maintain the improved range of motion achieved following more passive exercises like stretching.

Second, those with a history of ankle sprains or chronic ankle instability may have increased tone in the muscles around the ankle (Serra-Ano et al, 2021), which can cause a perceived sensation of stiffness. Strengthening can help normalize the tone and function of the ankle muscles, and can help improve overall joint range of motion, especially if performed dynamically (Alizadeh et al, 2023).

Strengthening exercises are crucial for proper ankle sprain rehab and is imperative to restore function and reduce risk of future injury. A progressive approach is usually taken, whereby more isolated and gentle exercises are performed earlier in the rehab process, and more aggressive and dynamic exercises performed in weight-bearing positions may take over later in the rehab process.

Example Ankle Strengthening Exercise

– Sit on a chair, couch, or bed with both legs out in front of you.

– Tie a resistance band around the midfoot or forefoot of the injured side.

– Place the band on stretch, loop it around your other foot, and hold the other end in your hand.

– For example, if you are strengthening the left ankle, tie the band around the left midfoot or forefoot, stretch the band out and loop it around your right foot, and hold the other end of the band in your right hand.

– Without rolling your whole leg out to the side, lift the outside of your foot (lateral aspect of your foot) up towards the side of your leg against the resistance of the band and slowly return to your starting position.

– You should feel the muscles on the outside of your leg contract to perform this motion.

– This exercise helps strengthen the peroneal muscles on the outside of your lower leg, which are very important to help resist rolling the ankle. These muscles are crucial for ankle stability, and as such, this is a very common exercise to perform following a lateral ankle sprain.

– The amount of sets, reps, and level of resistance can be guided by your physiotherapist and will vary depending on where you are at in the rehab process and what your goals are.

– For a focus on strength, you would increase the resistance and decreased the repetitions (e.g. 4 sets of 5 reps).

– For a focus on endurance, you would lower the resistance and increase the repetitions (e.g. 3 sets of 20 reps).

Figure 4. Example of peroneal muscle strengthening by performing left ankle eversion against the resistance of a band.

Functional Activity

Finally, once you are close to restoring your normal ankle range of motion and strength and are cleared by your physical therapist to resume most activities, participating in functional activity can be a more enjoyable way to continue building resilience of the ankle and maintain the reduction of stiffness that you achieved throughout the rehab process.

For example, if one of your goals is to return to long hikes, it may be advisable to first go on walks around the neighbourhood and gradually increase the amount of hills you are walking up or down. This will help build the capacity towards hiking, ensuring that you don’t run into problems on your first hike back, and that you don’t stiffen up too much after these types of activity.

Manual Therapy

While exercise-based rehab offers the most effective way to restore ankle mobility and overall function following an ankle sprain, a physical therapist may also be able to provide manual therapy to help with a stiff ankle after a sprain.

In this case, there are a variety of techniques that may be introduced and will depend on the nature of the injury and the physical therapist’s expertise. Some treatment methods that may help with a stiff ankle include hands-on stretching, soft tissue release and/or massage, dry needling, and ankle joint mobilizations.

Hands-on range of motion and stretching techniques may be used both as demonstration of what to do at home, and also to assist in improving ankle range of motion within a session.

Soft tissue release and massage can also help reduce stiffness, but the effect is often temporary unless followed up on with rehabilitation exercises. The calf muscle is often targeted in this case, as loosening up the calf will make it easier to restore full dorsiflexion range of motion.

Dry needling can also help release muscles and normalize the contraction of muscles after ankle sprains or other conditions that cause muscle dysfunction. Dry needling may used on the calf muscles, peroneal/fibular muscles, tibialis anterior, tibialis posterior, and possibly other muscle of the lower body that may be dysfunctional after an injury.

Ankle joint mobilizations are specific techniques that are usually performed by the physio, but in some cases can be taught as home exercises if the proper equipment is available. Ankle joint mobilizations are often done with the joint capsule itself is limiting range of motion, but very light forms of mobilization can also be performed to assist with pain reduction.

While these techniques can certainly be effective in helping with stiffness after an ankle sprain, and can also help with chronic ankle pain, they must be done in combination with exercise-based rehab for optimal results.


Finally, once you are close to restoring your normal ankle range of motion and strength and are cleared by your physical therapist to resume most activities, participating in functional activity can be a more enjoyable way to continue building resilience of the ankle and maintain the reduction of stiffness that you achieved throughout the rehab process.

For example, if one of your goals is to return to long hikes, it may be advisable to first go on walks around the neighbourhood and gradually increase the amount of hills you are walking up or down. This will help build the capacity towards hiking, ensuring that you don’t run into problems on your first hike back, and that you don’t stiffen up too much after these types of activity.


Alizadeh, S., Daneshjoo, A., Zahiri, A., Anvar, S. H., Goudini, R., Hicks, J. P., … & Behm, D. G. (2023). Resistance training induces improvements in range of motion: A Systematic Review and Meta-analysis. Sports Medicine53(3), 707-722.

Prince III, R. M., Lubberts, B., Buda, M., Guss, D., & DiGiovanni, C. W. (2019). Symptomatic venous thromboembolism after non‐operatively treated foot or ankle injury. Journal of Orthopaedic Research®37(1), 190-196.

Serra-Añó, P., Inglés, M., Espí-López, G. V., Sempere-Rubio, N., & Aguilar-Rodríguez, M. (2021). Biomechanical and viscoelastic properties of the ankle muscles in men with previous history of ankle sprain. Journal of biomechanics115, 110191.


The content here is designed for information & education purposes only and is not intended for medical advice.



John Schipilow

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