In Spanish orthopedic clinics, ankle sprains remain one of the most common injuries, especially among active people and casual athletes. However, many patients, as soon as the swelling and pain subside, decide to abandon their rehabilitation and return to their routine as if nothing had happened.
This tendency to "cut off" treatment prematurely worries specialists such as traumatologist Rodrigo Hidalgo , from the Traumatology and Orthopedic Surgery service of the Quirónsalud Plaza Euskadi Medical Center , who warns that interrupting the process too soon multiplies the risk of chronic instability , successive relapses and, in the long run, problems of joint wear and tear.
Rehabilitation: much more than a simple complement
According to the expert, the functional recovery phase is not an optional add-on, but an essential part of sprain treatment . In fact, he often reminds his patients that physiotherapy, strengthening, and proprioception work represents, in practical terms, "approximately half" of the injury healing process.
In practice, this means that it's not enough to simply wait for the ankle pain to subside. If the person only stays in the initial phase—relative rest, inflammation control, and protection—and doesn't complete the active part of the treatment, the ankle may appear recovered but remain weak and unstable during sudden movements, twists, or changes of direction.
Specialists insist that the goal is not only to eliminate the pain, but also for the joint to regain its dynamic stability , its ability to react and support the body's weight in real-life situations, such as walking on uneven terrain, going down stairs, or playing sports.
Therefore, well-designed rehabilitation programs include progressive muscle strengthening exercises and proprioceptive training, which force the ankle and leg muscles to adapt to different stimuli and respond quickly.
When this work is interrupted prematurely—due to haste, a subjective feeling of improvement, or lack of follow-up—the patient believes he is cured, but in reality, he maintains an ankle more vulnerable to new sprains and relapses.
A sprain isn't always "mild": why this injury is underestimated
As orthopedic surgeons point out, in Spain ankle sprains are still considered a minor injury, almost a routine matter. Many sufferers barely see a doctor, simply applying ice for a few days and, once the swelling subsides, resuming their normal activities without further follow-up.
However, clinical data shows that not all sprains heal well with minimal treatment. Hidalgo himself points out that, although it is a very common musculoskeletal injury , there are cases in which the ligaments suffer more significant damage and require closer monitoring.
The problem with treating "all sprains as minor" is that it overlooks signs of persistent instability , small weight-bearing difficulties, or feelings of insecurity that the patient normalizes. Over time, that joint, which never fully recovered, ends up causing problems every few weeks or months.
Furthermore, after the initial days of intense pain and swelling, it's common for people to experience rapid improvement and become complacent. As the discomfort subsides, many stop attending physiotherapy sessions and abandon the prescribed exercises, precisely when they should be starting to work more seriously on strengthening the ankle muscles and improving their balance.
Foot and ankle specialists therefore emphasize the importance of carefully assessing each case, especially in athletes, workers who spend many hours on their feet, or patients who have already suffered previous sprains in the same joint.
Ligaments, muscles and proprioception: this is how a stable ankle is achieved
One of the points that orthopedic surgeons emphasize most is that ankle stability doesn't depend solely on the ligament injured in the sprain. The joint remains stable thanks to a combination of ligaments and muscles , along with the nervous system's control over balance.
A sprain involves damage to the ligaments , which are the "bands" that hold the ankle bones in place. But proprioception is also compromised ; that is, the body's ability to perceive the joint's position in space and react automatically to changes in weight distribution.
A well-structured rehabilitation program therefore includes a specific set of exercises that work the ankle on unstable surfaces , involving changes of direction, single-leg support, and functional movements similar to those used in daily life and sports. It's not just about gaining strength, but about regaining fine motor control.
When this phase is ignored or abandoned because the patient no longer feels pain, the ankle may be left with a deficit in neuromuscular control . In practice, this translates into more frequent stumbles, sprains with relatively small twists, and a feeling of insecurity when running, jumping, or walking briskly.
This lack of stability makes each new sprain easier to suffer and, sometimes, more difficult to fully recover from, entering a vicious cycle of repeated injuries that gradually deteriorates the joint.
Relapses and early osteoarthritis: the consequences of “stringing together” sprains
Experts emphasize that each new sprain is not a simple isolated incident, but rather an additional impact on the ankle that adds to the previous damage. With each repeated sprain, the ligaments can loosen, the joint capsule becomes strained, and the cartilage begins to wear down prematurely.
This process, if left unchecked, can lead to early-onset ankle osteoarthritis , a degenerative condition that causes chronic pain, stiffness, and limitations in walking or playing sports. In active and relatively young people, this scenario represents a significant change in quality of life.
Hence the emphasis on not trivializing sprains and taking rehabilitation seriously, even when the first episode seems minor . Treating the initial injury properly reduces the likelihood of relapses and protects the ankle in the long term.
Orthopedic surgeons remind us that the risk of suffering new sprains is especially high in the first few months after an injury, precisely when many people relax their care and stop doing their rehabilitation exercises . Maintaining a longer strengthening routine, adapted to the activity you will be doing, can make all the difference.
For athletes or people with physically demanding jobs, a continuous prevention plan is usually recommended that includes ankle exercises integrated into the usual warm-up, to strengthen the joint and reduce the risk of falling back into a spiral of sprains.
The role (and limitations) of ankle supports and bandages
Another common mistake that specialists point out is relying too heavily on ankle braces, bandages, or external supports . These devices can be very useful in specific phases of treatment, for example, right after an injury or during a gradual return to sport, but their prolonged use without proper guidance can be counterproductive.
The reason is that any external system supporting the joint is, to some extent, doing the work that the muscles surrounding the ankle should be doing . If the patient gets used to wearing an ankle brace for everything—even for everyday activities without much exertion—those muscles work less and tend to weaken.
Hidalgo emphasizes that the ultimate goal should always be for stability to come primarily from the patient's own muscles and good neuromuscular control , not from external aids. Otherwise, the patient may feel secure while wearing the ankle brace, but remain vulnerable once it is removed.
Therefore, traumatologists recommend using these supports in a timely and supervised manner , usually in the early stages of returning to activity or in sports with intense changes of pace, and always combining them with an appropriate exercise program.
In daily life, the general recommendation is to gradually remove ankle braces and bandages as the joint gains stability, rather than turning them into a permanent crutch that prevents the muscles from doing their supporting function.
When should surgery be considered for an ankle sprain?
Although the vast majority of ankle sprains are successfully treated using conservative methods —relative rest, physiotherapy, strengthening, and proprioception—there are situations in which, despite having completed adequate rehabilitation, the joint continues to fail.
In these cases, when clear signs of instability persist (repeated failures to bear weight, a feeling that the ankle "gives way," multiple sprains with minimal effort), specialists assess the possibility of repairing or reconstructing the injured ligaments through surgery.
Today, available surgical techniques allow these problems to be addressed in a minimally invasive manner , reducing the size of incisions, postoperative pain, and hospital stay. The goal is to restore lost ankle strength and improve the patient's quality of life.
According to traumatologist Hidalgo, depending on the condition of the tissue, one can opt for a direct repair of the damaged ligament or for a ligamentoplasty, a procedure in which the ligamentous structure is reconstructed when it is severely deteriorated.
These treatments are usually performed using ankle arthroscopy , a technique that allows working inside the joint with the help of a camera and specific material, minimizing the aggression to the tissues and facilitating a more controlled and predictable recovery.
Recovery time after surgery and return to activity
The timeframes for returning to normal life after ankle instability surgery vary depending on the type of surgery performed and the characteristics of each patient, but specialists use indicative references that serve as a guide.
In surgeries where ligament repair is performed without the need for complete reconstruction, the estimated time to return to daily activity is usually between three and four months, provided that the postoperative rehabilitation protocol is respected.
When ligament damage is more extensive and requires reconstruction (ligamentoplasty) , the recovery time is longer. In these cases, the gradual return to normal activities usually takes between four and six months, depending on the level of physical exertion and the type of sport the athlete wishes to resume.
In any scenario, rehabilitation remains a key pillar after surgery. Progressive mobilization, strengthening, and proprioception exercises, guided by healthcare professionals, are essential for the ankle to regain its function and reduce the risk of further injury.
Therefore, traumatologists emphasize the importance of following medical check-ups , respecting the established timeframes, and not rushing the return to intense sport, even when the patient notices a subjective feeling of faster improvement.
Taking ankle sprain rehabilitation seriously , not shortening the recovery time on your own, and avoiding excessive reliance on external support are crucial factors in preventing this common injury from becoming a chronic problem, with continuous relapses, persistent instability, and a higher risk of early osteoarthritis in the joint.
