How is a sprained ankle graded?

December 29, 2022

An ankle sprain is an acute injury that affects one or more of the ligaments that support and
stabilize the joint. Ligaments are flexible, fibrous bands of connective tissue that connect
bones to each other and bind the joints together.

Your ankle joint has several ligaments, including three major ones on the outside of the
ankle that comprise its lateral ligament complex. These tissue bands allow for normal
motion and restrict excessive lateral movement.

A sprain occurs when one or more ligaments are overstretched or torn. This usually occurs
because of a sudden, twisting movement or an intense impact. A sprain shouldn’t be
confused with a strain, which affects muscles rather than ligaments.

Ankle sprains are common in sports like tennis, basketball, football, and soccer where high-
impact activities require quick directional changes.

Ankle sprain diagnosis and grading
5 main symptoms of an ankle sprain (vary in intensity depending on the severity of the injury):

• Acute ankle pain and discomfort
• Inflammation and visible swelling
• Ankle instability; limited mobility
• Bruising over or around the ankle
• Inability to bear full body weight

Ankle sprains are categorized as mild, moderate, or severe based on the degree of trauma
and the number of ligaments involved. Damage and symptoms are worse with each progressive
grade level:

Grade I sprain
A mild Grade 1 sprain occurs when an ankle joint ligament becomes overstretched and/or
sustains minor, microscopic tears. Manageable pain, mild swelling, and slight joint stiffness
are normal; bruising isn’t common.

Grade 2 sprain
A moderate Grade 2 sprain means one or more of the stabilizing ligaments in your ankle
joint have sustained significant partial tears. This level of trauma is more likely to cause
bruising, continuous pain, and swelling that makes it difficult to move your ankle.

Grade 3 sprain
A severe Grade 3 ankle sprain occurs when a ligament tears all the way through or
ruptures, resulting in a complete loss of joint stability and integrity. Immediate, severe pain
and swelling are common; you may also hear a “pop” when it happens. Bruising often
appears later.

Immediate Action (P.R.I.C.E. )

When you or a teammate experience a sprained ankle remember (P.R.I.C.E.) for immediate
action.

Then schedule a visit with one of our experienced sports doctors at Connected Whole Health to ensure you make a full recovery.

✒️ Chief Editor: Dr. Bill Moreau | DC, DACBSP, FACSM | Chief Medical Officer