The 72-Hour Acute Ankle Sprain & Roll Protocol

The Physio-Approved roadmap to safer early healing & future stability.
A clear checklist for everyday people and athletes so you know what to do immediately after rolling your ankle — and when to get help.
Last updated: 17 Feb 2026
Sports trainer taping ankle for soccer — acute ankle sprain protocol

The PhysioApproved clinical approach to acute ankle sprains.

Book a Physio Telehealth Triage (15–25 min)

First 24 Hours — PEACE Phase

Goal: Protect ligaments and manage swelling while keeping the normal healing response intact.

  • Protect: Stop activities that spike pain; wear supportive footwear. If you have the PhysioFit™ Anti-Roll Brace, use it for stability to reduce "re-rolls".
  • Elevate: Prop ankle above the heart when resting, repeat often.
  • Compression: Keep it snug but comfortable. Avoid numbness or color changes.
  • Avoid anti-inflammatory overload: Skip aggressive icing routines. Ice for 10–15 min only if pain is distressing.
  • Educate + Gentle Motion: Perform hourly ankle pumps (10–20 reps) and toe wiggles to assist circulation.

24–72 Hours — Optimal Loading (LOVE)

Goal: Transition from protection to active recovery — safely.

  • Load as tolerated: Short, frequent walks usually beat total rest (do not flare it).
  • Limp-free goal: Aim for heel-to-toe walking. If limping persists, continue support or use crutches temporarily.
  • Pain rule: Mild discomfort is OK. Sharp pain or a next-day swelling spike means you did too much.
  • Light starter strength: If tolerated, try gentle isometrics 3×30–45s without sharp pain.
  • Medication note: Prefer paracetamol if needed/appropriate. Avoid routine NSAIDs in the first 24–72h unless advised.

What NOT to Do — H.A.R.M (First 72h)

Goal: Avoid early choices that can increase swelling, bleeding, or re-injury risk.

  • Heat: Avoid hot baths, saunas, and heat packs.
  • Alcohol: Increases swelling, masks pain, and worsens coordination.
  • Running/Impact: Don’t test the joint with jumps or runs. Limping = not ready.
  • Massage: Avoid deep massage directly over the injured ligament early on.

Seek urgent medical review if:

  • Visible deformity or severe worsening pain.
  • Numbness, tingling, or the foot turns cold/blue.
  • Inability to weight-bear (or worsening inability).
  • Suspected fracture or pain directly on the bone.

Next Step Checklist — When to Get Help

Goal: Spot a simple sprain vs. a higher-grade injury that needs professional assessment to reduce the risk of chronic instability.

  • 1. Ottawa Ankle Rules (X-ray screening)

    Seek medical review/X-ray if you cannot take 4 steps OR have bony tenderness at the back/tip of either ankle “knob”, the base of the 5th metatarsal, or the navicular.

  • 2. Swelling & bruising trend

    If swelling/pain is worsening at 48–72h, or you have extensive bruising + inability to bear weight, get assessed.

  • 3. Proprioception check

    Supported single-leg stand: compare good vs. injured side. If the injured side feels “lost” or wobbly, you likely need structured rehab.

  • 4. Professional pivot

    Mechanical catching/clunking, marked instability, sharp pain not easing, or no meaningful improvement by 72h → book a physio review.