Do you remember jumping up for a rebound or going for a spike, only to land awkwardly on someone’s foot—and instantly drop to the ground clutching your ankle in pain? If you’re an athlete or someone who loves to stay active, chances are you’ve experienced at least one ankle sprain in your athletic career. It’s the most common lower body injury in sports, especially in basketball, volleyball, and other court-based games. Ankle sprains don’t just affect your ability to play—they disrupt workouts, limit mobility, and can become chronic if not managed properly. Whether you're recovering from a sprain or looking to prevent one, this blog breaks down everything you need to know in a way that’s clear, actionable, and useful.
Understanding the Anatomy of Your Ankle
To understand how ankle sprains happen—and how to decrease the risk of them—you first need to understand what’s going on in your ankle. The ankle is a joint where four bones come together: the tibia and fibula (your lower leg bones), the talus (a small bone in the middle), and the calcaneus (your heel bone). These bones work together at two joints: the talocrural joint, which allows the foot to move up and down, and the subtalar joint, which helps the foot tilt side to side.
What holds it all together are ligaments—strong, fibrous tissues that connect bone to bone. On the outside (lateral) part of the ankle, you have three key ligaments:
- Anterior talofibular ligament (ATFL)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
On the inside (medial) part, there’s a strong group of ligaments called the deltoid complex. And between your tibia and fibula lies the syndesmosis, a ligament which keeps those two bones together. When any of these ligaments are stretched or torn, we call it a sprain—and depending on which ligament is injured, the sprain is categorized as inversion, eversion, or high ankle.
The Mechanism of a Sprain: How It Happens
Ankle sprains happen in the blink of an eye. One wrong step or awkward landing, and suddenly your foot twists too far in one direction.
Inversion sprains, the most common type, occur when your foot rolls inward—usually when landing on the outer edge of your foot or stepping on someone else’s foot. This stretches or tears the ligaments on the outer side of your ankle, most commonly the ATFL.
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Eversion sprains are the opposite. The foot rolls outward, overstretching the ligaments on the inside. These are less common but can still occur with certain missteps or uneven surfaces.
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High ankle sprains, also known as syndesmosis sprains, usually happen in contact sports like football or rugby. These occur when your ankle is forcefully twisted outwards while it's planted—often during a tackle—causing damage to the ligaments that connect your tibia and fibula.
Out of the three, inversion sprains are the ones we see most often, especially in court athletes or those playing sports involving jumping, running through contact, and cutting motions.
Why Inversion Ankle Sprains Are So Common—And How to Stop Them
So why do inversion ankle sprains happen more than the others? A lot of it comes down to weakness and control. Weak ankles, particularly if the surrounding muscles are weak or fatigued, are more vulnerable to twisting. But it’s not just about the ankle. Weak hips, especially hip abductors, play a huge role in poor lower-body control and instability with dynamic movements. A 2021 study even linked hip abductor weakness to a higher risk of inversion sprains in soccer players.
Poor single leg balance is another major factor that could contribute to risk of ankle sprains. If you struggle to stay steady on one leg or have poor body awareness (known as proprioception), your body can’t react quickly enough when your foot lands in an abnormal position. A high body mass index can also increase the strain on your ankle during awkward landings or changes of direction. Interestingly, female athletes appear to have a slightly higher risk of ankle sprains due to both anatomical and hormonal factors.
Sometimes, the sprain is just bad luck—like landing on someone else’s foot—but there’s still a lot you can do to lower your risk and bounce back fast if you do happen to sprain your ankle. Strength training for your ankles and hips, practicing single-leg balance drills, and incorporating dynamic exercises like single leg hopping and lateral movements are essential. For those athletes who want to be proactive or coming back from injury, I personally use the ASO ankle brace when I hoop. A brace or ankle taping can provide extra support and help your brain stay better connected to your ankle while playing your sport.
You Sprained Your Ankle—Now What?
If you roll your ankle, the first thing to do is stay calm and take it slow walking it off. If you can't put any pressure on the ankle then crutches and a visit to your orthopedic doctor is recommended.
Sprains are typically categorized into three grades:
- Grade 1 is a mild stretch of the ligaments with minimal swelling and discomfort.
- Grade 2 involves a partial ligament tear, moderate swelling, mild bruising, and noticeable difficulty walking
- Grade 3 is a full tear of the ligament, resulting in significant swelling, severe, pain, bruising, and joint instability.
Your first 24 to 48 hours should focus on managing swelling and protecting the joint, but the old RICE method is outdated. We now follow the PEACE & LOVE protocol.
If you’re unsure whether your ankle is sprained or fractured, the Ottawa Ankle Rules can help guide that decision. If you can’t put weight on the ankle or have specific areas of bone tenderness and pain, it’s time to get an X-ray. Either way, it’s a good idea to visit a sports physical therapist or orthopedic provider who can assess your ankle injury properly.
At Crossover, we take you through a detailed evaluation that includes range of motion measurements, strength tests, and movement analysis. Then we build a plan to get you out of pain, rebuild your strength, and most importantly—get you back to sport. Rehab includes mobility work, progressive loading, strength training, balance and proprioception drills, and eventually return-to-play testing with sport-specific exercise.
Keeping Your Ankles Strong, Stable, and Injury-Free
Whether you’ve already experienced a sprain or you just want to stay ahead of the game, long-term ankle health comes down to smart, consistent training. Strengthening your lower leg muscles with exercises like resisted ankle movements and dynamic single leg exercises helps provide a strong foundation. But don’t stop there—your hips and glutes also need attention. Think hip thrusts, side steps with bands, RDL's, and lateral lunges to build strength where it matters most.
Balance should also be part of your routine. If you can hold a single-leg balance for at least 30 seconds on a flat surface, you’re in a good place. Want to level up? Try doing it while bouncing a ball or catching and throwing a ball.
Once you’ve built strength and balance, it’s time to introduce plyometrics—quick, explosive movements that teach your body to absorb and redirect force. Hopping on one leg, jumping in diffferent directions, and sport-specific cutting drills will condition your body to handle the chaos of real-life athletic movement.
Finally, when returning to high-intensity activity or competing in high-risk sports, taping or bracing can be a smart preventative tool. Not only do braces like the ASO offer stability, but they also improve proprioception by helping your brain stay connected to what’s happening at your joint.
If you are an athlete and want more information on how to help heal and decrease your risk of ankle sprains, click below to download our FREE E-Book.
Final Thoughts
Ankle sprains are common—but they don’t have to be your norm. With the right understanding, training strategies, and recovery plan, you can come back stronger and more resilient. If you're a Tampa athlete and love playing basketball, running marathons, or crushing a CrossFit workout, protecting your ankles means maximizing your performance and long-term health.
And if you ever need help building a plan—or you’ve recently rolled your ankle—our team at Crossover Physical Therapy and Performance is here to help. When you’re ready, we’ll help you move better, train harder, and stay in the game!
References
- Al-Mohrej OA, Al-Kenani NS. (2017). Acute ankle sprain: conservative or surgical approach? EFORT Open Rev, 1(2), 34-44.
- Gaddi D et al. (2022). Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Front Med (Lausanne), 9:868474.
- Halabchi F, Hassabi M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop, 11(12):534-558.
- Kaminski TW et al. (2019). Prevention of Lateral Ankle Sprains. J Athl Train, 54(6):650-661.
- Kawaguchi K et al. (2021). Hip Abductor Muscle Strength Deficit as a Risk Factor for Inversion Ankle Sprain in Male College Soccer Players. Orthop J Sports Med, 9(7):23259671211020287.
- Mason J et al. (2022). Intrinsic Risk Factors for Ankle Sprain Differ Between Male and Female Athletes: A Systematic Review and Meta-Analysis. Sports Med Open, 8(1):139.
- Roos KG et al. (2017). The epidemiology of lateral ligament complex ankle sprains in NCAA sports. Am J Sports Med, 45(1):201–209
