The first 48 hours after you roll an ankle

You went over on it. It swelled up within the hour. Here is what actually matters in the first two days, and what does not.

First, rule out a break

Most rolled ankles are ligament, not bone. A few are not. Get an x-ray if any of these are true: you cannot take four steps on it, there is bone tenderness on the back edge or tip of either ankle bone, or there is bone tenderness on the outside of your midfoot.

Those are the Ottawa ankle rules, and they are good enough that emergency departments use them to decide who gets imaged. If none apply, an x-ray is unlikely to change anything.

What to do

Keep weight on it as much as pain allows. Limping is fine. Hopping around on one leg for a week is not helpful, and crutches are for people who genuinely cannot bear weight, not for comfort.

Elevate it above your hip when you are sitting. This does more for swelling than anything else on this list, and almost nobody does it enough.

Compression helps. A simple elastic bandage or a compression sock, firm but not tight enough to change the colour of your toes.

Start moving the ankle within a day or so. Small circles, up and down, pain-free range. Early motion is one of the few things with decent evidence behind it.

What matters less than you think

Ice is fine for comfort. It does not appear to speed healing. Use it if it helps you move about more comfortably, skip it if it does not, and do not build your week around it.

Anti-inflammatories are the same story. They will take the edge off. There is a reasonable argument that heavy use in the first few days blunts part of the healing response, so use them if you need them and stop when you do not.

Swelling is not a good guide to severity. Ankles swell dramatically over very little.

The part everyone skips

A rolled ankle damages the position sense in the joint, not just the ligament. That is why the second sprain is so much more likely than the first, and why people who sprain an ankle once often go on to do it three or four times.

Balance work fixes this, and it is cheap: standing on one leg, then with your eyes closed, then on something unstable, then while doing something else with your hands. A few minutes most days for six weeks or so.

It is dull and it is the single most protective thing you can do. Almost nobody does it without being told, which is a large part of why we bring it up in the room.

When to come in

If it is not clearly improving after a week, if it keeps giving way, or if you have done it more than once, book in. Repeat sprains are a solvable problem and they are much easier to solve early.