Grade 3 Ankle Sprain - Treatment options 5 months post-injury

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Hi all,

I sprained my ankle really bad early Jul'17. I chose not to cast it (did an xray, fracture was ruled out) however did not know extent of ligament damage. 

I wore a walking boot and was weightbearing - even though it hurt a lot. Once I could walk, I would push myself, and after a few weeks even did 2 5k runs (with it hurting - thought if I treated it 'normally' it should be fine). I even did heavy weightlifting with it. 

3 months post injury, it would still hurt. Got an MRI: Complete tear ATFL, severe tear CFL, and several tendon injuries. Also a small avulsion fracture where my ligament was pulled. 

Started PT a month ago and stiffness has improved a lot, however there is still pain and swelling.

Not sure if anyone has been in similar situation - is it worth casting at this stage? Will PT help at this stage? What are my non-surgical options? I want to avoid surgery at all costs. I don't feel unstable, just chronic pain and swelling. Stability, ROM and Stiffness seems manageable, but pain pain pain!

Thanks in advance for any insights. 

1 like, 27 replies


27 Replies

  • Posted

    Hey I just thought I would respond with what helped me through my grade 2.

    1) Balancing heat and ice. Heat before activity and ice before rest!

    2) BIM Resistance Bands. We tried many resistance bands as therapy for her back but many snapped and were not durable for my needs. BIM resistance bands are made with professional grade fibers and have not even ripped a little bit in the past 3 months. He is a link to them:

    3) Overall mood. I think it is important to realize that there will be some good days and some bad days but you cant let that ruin your vision of getting better. You will get better, like my girlfriend did. Just believe and you will.

    • Posted

      Hi Bryce,

      Thank you so much for your insights - good to know about this brand! Have been using these bands during PT and wanted to buy a set for home so will look into BIM.

      I think the mood is the worst part, not going to lie. I'm a very very very very active person (run in the mornings, gym in the evenings, and just generally prefer walking everywhere than taking transport) so this has been a blow to my lifestyle to say the least!

      Really glad to hear about your girlfriend getting better - hoping for the best! I think I'm a bit in a shock as I genuinely didn't realise how bad it could be... guess that comes with being young and thinking I was invincible. Huge reality check. 

      Am taking my PT and rehab quite seriously and have minimal activity (and trying to cope with that!) so lets see how it goes in the next few months as I only started PT last month (3months post injury) and hope that within those 3 months I didn't screw it up for life!

      Thanks a lot. 


  • Posted

    Hi RS,

    It sounds like you got some proper treatment for your ankle sprain initially. It probably was not a super good idea to start running again so early after injury. Perhaps that is what stalled your recovery and put you in your current stalemated condition.

    All ankle sprains are not created equal. Some people are lucky with a Grade I type sprain with no ligament tears or other complications. After a short recovery they are usually back to sports and other activities.

    Since you had complete ligament tears that would likely place you in the worst Grade III category. This type usually requires much more time to recover, and postpones return to sports etc.for a longer time.

    You might still benefit from resting ankle in an air boot or trying a sturdy ankle brace. But I would definitely hope you are under the care of a competent sports medicine ankle specialist who could lead you by the hand out of this nightmare.

    Good luck to you.


    • Posted

      Hi, thanks so much for your reply!

      Yes, looking back I shouldve been more sensible about the running... if only I knew and understood the severity of my injury. I only found out 3months after since it was still hurting and extremely stiff.

      Im OK if it takes long to recover, but just need it to recover without surgery. Like I said biggest issue is pain... cant sleep for nights as the pain from the ankle migrates up my leg.

      Is this normal? Ive only just started physical therapy/rehab for 1.5months... so is there chances of me recovering even if I started PT 3months after my injury? Im happy to even do it for a year if itll help and not do surgery!

      Also, since I didnt cast it, does this have severe impacts?

      Meeting my doc tmr to discuss this casting and pain issue.

      Thank you so much!!

    • Posted


      Well, we live and learn. You are not the first ankle patient to rush into sports too soon after an injury, and you most assuredly will not be the last.

      I hope for your sake you are under care of a specialist who is intimately familiar with your type of injury. Preferably a specialist who is not also a surgeon.

      While some surgical intervention is absolutely required in some injuries, it seems to me that too many patients are looking for an immediate solution and believe in idea of surgery as if it is a magical cure-all. It is not.

      Your question second-guessing whether you should have been casted from start-- only your doc knows for sure. An airboot or air cast (or maybe just a top shelf sports quality ankle brace) would probably be sufficient to immobilize and protect soft tissue immediately after accident.

      Again, good luck to you.

    • Posted

      'Well, we live and learn.' --> I think that's exactly what I needed to hear. I felt like such a fool to make such a stupid mistake. But I am learning (albeit the hard way - think I reinjured it with yoga...) but am really putting in my 100% with the physio and rehab. 

      Also completely agree about the surgery - to be honest I considered it too thinking its a 'quick fix' solution - and after reading some literature in the area, realised it is anything but. 

      My doctor (in my opinion) is pretty good and thorough, and he said to do rehab for 6months and see how I feel. My physio even said I should be able to run my half marathon by next year! Being too hopeful maybe? Im not sure but ill take the optimism for now - could really use some! It's been difficult on the lifestyle to say the least but I'm realising long term impacts and will be keeping my ankle in as much rest, whilst still maintaining exercise through swimming with a noodle between my legs. 

      Sorry I'm kindof using this space to also vent and outline my thought process, so forgive me for the long posts! It's just nice to discuss it smile 

  • Posted

    hi Bro,

    I hope you are doing good.

    I wish you a speedy recovery.

    I am also in similar situation, i have injured on nov 4,2017.the pain and swelling was there for a day. Now i am able to walk and run, but MRI says atfl ligament complete tear. No other injuries or tears.My doctor is suggesting an surgery. Can you please suggest me on this.

    • Posted

      Hi there,

      No. I really think you should see another doctor - surgeries are a LAST RESORT when you cannot do anything and if youre ankle is extremely unstable. I have been up for many nights just reading and reading and reading. 

      If you are able to walk and especially run, I wouldn't even consider surgery. What I'm doing now is physio and rehab - for me it still hurts... and my doc said at least 6months of rehab. NOT SURGERY. Do NOT go down that route unless there is no other option. 

      Even if you can walk, I strongly suggest rehab and this would strengthen your ankle and prevent future problems that may occur due to the tear. 

      I beg you to look into this more as surgery for the ankle is not like other body parts... it literally takes all your weight and healing takes up to 2years. And more that that, is simply unnecessary. 

      Hope that helps - let me know if you need any more help!

    • Posted

      Thank you Bro.I am seeing another doctor on monday. Can you please share your doctor contact details. I would like to get in touch with him
    • Posted


      So sorry for the late response! I'm actually in Bangkok so can't help you there - but I really really suggest seeing a rehab specialist/sports doctor/foot & ankle specialist and not a surgeon to get another perspective. 

      Let me know how it goes again with your doc.


  • Posted


    I hope you’re doing well,

    I too sprained my ankle jan 12,2018. And the MRI said that I have a grade 3 injury (completely torn atfl) and other injuries ( grade 2 sprain in the calcaneo ligament).

    Sadly I have both ankles sprained but the left one is more severe. I’m really feeling down and can’t stop thinking that I’ll probably never going to be able to walk normally ever again. 

    Though I’m 20 years old but the first doc I went to said I needed to get a surgery (and I said NO of course). went to 2 other doctors both didn’t suggest surgery and told me that even a completely torn ligament can heal through time. 

    I’m wearing a walking boot now and struggling to cope with the lifestyle change (2nd semester started but can’t go to uni yet) and I hate being dependent on others (though I’m very very greatfull for my family)   

    Anyway, I wanted to ask how are you doing now? Is the pain gone and the ligaments are heald? 

    And I also want to say should I rest and set all day long or should I put weight on the ankles and move them more?( It’s been 2.5 weeks since injury) 

    • Posted

      Ah I had typed up a huge long msg and it didnt save! Anyhow wanted to say - talk about lifestyle... I was peaking in my fitness. Running half marathons, lifting like crazy. I walk everywhrre (dont know how to drive) and am excessively active (just turned 25yrs) so totally understabd. It did take a huge toll on me... fair share of tears and depression but you realise its all so superficial becauss you will recover smile

      Its been 8months for me and although im not back to 100%, it is SO MUCH BETTER. I did PT and rehab super ultra religiously - i ate everything right, nutritious food, antiinflammatory (turmeric w milk) and applied heat. I maxed out everything as I needed to get back in to running (and into wearing heels!) asap.

      Truth is for me its not 100% since I was diagnosed w trauma activated fibrous tarsal coalition... but when I do my PT exercises it feels tons better and when I stop it actually begins to hurt... so youll need to take care.

      Dont do surgery yet - give it AT LEAST 6MONTHS - you will be surprised. Yes i was depressed and sometimes I still cry xuz I cant run yet and thoughf I would pain for the rest of my life.

      But it will get better. Completely torn ligaments dont 'heal' - rather, you strenghten the muscles aroubd it so it compensates for the lacl of ligament and is strong enough do do so.

      Im happy for you get in touch if you want to talk further - I know its a debilitating feeling... but I swear itll improve. I.only found out anout my tear after 3months so youre very lucky!! Can starf rehab and PT sooner smile

      For exercise start of with non weight bearing i.e. range of movement and ankle strengthening before moving to weight bearing - but be sure to exercise your ankle otherwise scar tissue will make it stiff which hurts a lot to break!

    • Posted

      Hey i saw ur posts and would really like ur input.. I have grade 3 sprain from 11 weeks ago and thought itd be better by now. I need to be active for work so didnt want surgery but i need this to get better. Any way we can chat?
    • Posted

      Hi John - yes happy to discuss as I was im a similar siruation with surgery sounding tempting, but unnecessary.

      Please inbox me with your facebook and ill msg you on there!


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