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Part of Ankle sprain

How to prevent ankle sprains after you have had one

How to prevent ankle sprains, once you have sprained one, comes down to two things that work and that have actually been compared with each other: wearing a brace for sport, and doing balance training. In a three-arm randomized trial of 384 athletes who had sprained an ankle, 27 percent of the training group reported another sprain within a year against 15 percent of the brace group, a relative risk of 0.53 in favor of the brace (Janssen and colleagues, 2014). Measured against doing nothing, pooled data put bracing at a 64 percent lower risk across 3,581 athletes and balance training at 46 percent lower across 3,577 (Bellows and Wong, 2018). Tape and a soft brace came out much the same at one year in a non-randomized trial of 157 adults (Kemler and colleagues, 2015). The US physical therapy guideline still asks for both together after a first sprain, on strong evidence, and the reason is that they do different jobs: the brace protects the ankle while the balance work changes it. If you have never sprained an ankle, the picture is different, because the evidence for balance training as a first-time preventive is inconclusive (Schiftan and colleagues, 2015).

Warning signs, and when to get help

Why does a sprained ankle sprain again?

Because the first one leaves things behind, and most of them are invisible from the outside.

The International Ankle Consortium reviewed the evidence on this and describes recurrence after a lateral ankle sprain as common, with a large share of people going on to develop lasting instability, which in turn is associated with doing less physical activity, a lower quality of life and rising rates of ankle arthritis in later life (Gribble and colleagues, 2016). A systematic review of the clinical course of acute ankle sprains puts the risk of a repeat sprain anywhere between 3 and 34 percent across its 31 studies, with repeats recorded from 2 weeks to many years after the first injury (van Rijn and colleagues, 2008).

OrthoInfo names two of the reasons in a sentence each: poor balance often leads to repeat sprains and ankle instability, and a previous sprain is itself one of the things that makes another more likely. Put less politely, an ankle that has been sprained once is more likely to be sprained again, and the months straight after it are the period the preventive work has actually been tested in.

That is the point of this page, and it is a narrower subject than it sounds. It covers what lowers the odds for somebody who has already sprained an ankle. The exercises themselves are on ankle proprioception exercises, the staged program they sit in is the ankle sprain program, and the ankle that is already giving way regularly has its own page at chronic ankle instability, including the question of surgery, which this page does not answer. If you have had an operation on the ankle, your surgeon's protocol sets what support you wear and for how long, and it comes before anything here.

Does an ankle brace work?

Yes, and of the two options it has the larger numbers attached to it.

A meta-analysis of athletes wearing braces found fewer ankle sprains and a 64 percent lower risk, relative risk 0.36, based on 3,581 subjects (Bellows and Wong, 2018). An overview of systematic reviews reached the same place from a different direction, rating the evidence for bracing in preventing a recurrence as strong and the evidence for balance and coordination training as moderate (Doherty and colleagues, 2017). The US physical therapy guideline recommends a preventive brace on strong evidence, both to reduce the risk of a first sprain where risk factors are present and, after a first sprain, alongside balance focused exercise (Martin and colleagues, 2021).

One thing has to travel with the 64 percent, or it becomes a false comparison later on this page. In all eight studies behind that figure the comparison group had no intervention at all (Bellows and Wong, 2018). It is a measure of brace against nothing, not of brace against exercise.

What the trials actually did with braces is useful if you are deciding how to use one. In the head to head trial, the brace group wore a semi-rigid brace during all sports for 12 months (Janssen and colleagues, 2014). In the brace against tape trial, it was 4 weeks of wear after the sprain (Kemler and colleagues, 2015). Those are two different jobs: protecting a healing ankle in the first month, and protecting a vulnerable ankle in sport for a season. Both are reasonable, and neither requires wearing a brace around the house.

Brace or balance training, or both?

This is the question every patient asks and almost nobody answers, and it has been tested head to head.

Janssen and colleagues randomized 384 athletes aged 18 to 70 who had sprained an ankle into three groups: an 8 week home neuromuscular training program, 120 people; a semi-rigid brace worn during all sports for 12 months, 126 people; or both for 8 weeks, 138 people. At one year, 69 of the 384 reported a recurrence, which is 20 percent overall. By group that was 29 of 120 in the training arm, 27 percent; 17 of 126 in the brace arm, 15 percent; and 23 of 138 in the combined arm, 19 percent. The relative risk for the brace against training was 0.53, with a confidence interval of 0.29 to 0.97, and the trial concluded that bracing was superior to neuromuscular training for reducing the incidence, though not the severity, of self reported recurrent sprains after usual care (Janssen and colleagues, 2014).

It is an awkward result: the brace beat the exercises on sprain counts, and adding the exercises to the brace did not beat the brace alone in this trial.

Now read the guidelines, which still ask for both. The reason is in a separate recommendation: a brace or tape does not improve how well the ankle senses its position or how steady it feels, and the US physical therapy guideline instructs that a support should not be used as a stand-alone intervention for balance and postural stability in an ankle that keeps giving way (Martin and colleagues, 2021). The brace stops the ankle rolling past a certain point. It does not give you back the thing the sprain took.

So the brace buys you a season. The balance work is the only one of the two that changes the ankle itself, and it is the one that keeps working on the day you forget the brace. If you are going to do one, the trial says the brace prevents more sprains. If you want to stop having this conversation every year, do both, which is what the guideline recommends.

There is a second reason not to lean on the brace alone. Self reported recurrence over a year is what these trials counted, and none of them followed people for long enough to say what an ankle is like a decade later.

Tape or a brace?

Close enough that the choice can be made on practicalities.

Kemler and colleagues compared 4 weeks of a soft brace with 4 weeks of taping in 157 adults after a lateral sprain, allocating them alternately rather than at random, which makes this weaker evidence than a randomized trial. At one year, 13 of 76 in the brace group reported a reinjury, 17 percent, against 11 of 78 in the tape group, 14 percent, a risk difference of 3.1 percent with a hazard ratio of 0.9 and a confidence interval from 0.4 to 1.9. One secondary finding went against the brace: at one year the brace group had poorer scores on the manual anterior ankle test, a risk difference of 15.4 percent (Kemler and colleagues, 2015).

The overview of systematic reviews and the US guideline both give tape and braces a role without ranking them against each other, and the guideline's own framing is about the support being chosen to fit the person, the stage and the sport (Martin and colleagues, 2021; Doherty and colleagues, 2017).

Which leaves the practical questions. Tape has to be applied properly every time and is finished by the end of the match. A brace is reusable and takes less skill to put on, which is why it tends to be the one people stick with. Whichever you pick, have a physio watch you put it on once.

What about shoes, and preventing a first sprain?

Two things readers often hope for and the evidence does not supply.

Footwear is the first, and it has been tested rather than simply overlooked. The US physical therapy guideline reports 3 randomized trials with 3,410 participants between them comparing low-cut with high-cut footwear, which found no significant reduction in ankle sprain risk, and it states that footwear modification and orthotics have been shown to be ineffective for the general prevention of a later sprain, while leaving open whether they help a specific ankle or foot impairment (Martin and colleagues, 2021). Against that, OrthoInfo lists shoes that give the foot and ankle little support, and shoes with slippery soles, among the things that make a sprain more likely. The two are not in conflict. Playing in the wrong shoes for the surface is worth avoiding, and buying shoes as a way of preventing sprains is not supported.

Preventing a first ever sprain is the second, and here the picture divides. The US physical therapy guideline recommends a preventive brace to reduce the risk of a first sprain, particularly where risk factors are present, on strong evidence. For balance training in people who have never sprained an ankle, the same guideline gives only weak evidence, and the meta-analysis of proprioceptive training concluded that the benefits for primary prevention remain inconclusive, with the estimate resting on two trials that were not significant on their own (Martin and colleagues, 2021; Schiftan and colleagues, 2015).

The NHS says the plainest version of it, under a heading rather than in small print: you cannot always prevent sprains and strains. What it names underneath are causes rather than measures: not warming up before exercising, tired muscles, and playing sport.

If you came here from a sport, the sport-specific work is better handled sport by sport. Netball has its own page, including what the netball evidence says about taping and bracing, at netball ankle injury. Runners have running injuries, and the general testing question is on return to sport test battery.

How long do you keep it up?

Long enough to be dull, and the numbers give you something to plan around rather than an open-ended instruction.

The unsupervised home balance program that cut repeat sprains in 522 athletes ran for 8 weeks, and over the following year it lowered the share reporting another sprain from 33 percent to 22 percent (Hupperets and colleagues, 2009). The brace in the head to head trial was worn during all sports for 12 months (Janssen and colleagues, 2014). Put those two together and you have a reasonable shape for the year after a sprain: a couple of months of real balance work, and a brace for the sport you play while you do it.

The US physical therapy guideline adds one thing to that, which is where most people come unstuck. It puts optimized loading in the acute phase and on into the postacute phase, on strong evidence, and reports that exercise programs started early after a sprain brought a faster recovery (Martin and colleagues, 2021). What it does not do, and nor does anything else read for this page, is set a date for stopping. A short balance set in the warm-up is how physios usually make that stick, which is common practice rather than a tested plan.

Then there is the ankle that keeps going over anyway, despite the brace and the program. That is not a failure of this page's advice so much as a different diagnosis, and it belongs on chronic ankle instability, which is also where the question about an operation is answered. Deciding when the ankle is ready for the sport you are trying to protect it in is a separate judgement, set out on ankle sprain return to sport, and the wider timeline is on sprained ankle recovery time.

Related exercise programs

Warning signs

Get emergency help now

  • Emergency: the ankle or foot looks deformed or out of place, you heard a crack when you were injured, or the foot is numb, tingling, cold, pale or blue. Go to an emergency department straight away, and do not drive yourself.

Get help today

  • Same day: you could not take 4 steps right after the injury and still cannot, or the back edge or tip of either ankle bone is tender to press. Keep your weight off that foot as much as you can, leave the exercises out, and get it checked for a fracture the same day. These are part of the Ottawa ankle rules, explained on the ankle sprain page.
  • Same day: the pain is in the middle of your foot, and the bony bump halfway along the outer edge of the foot or the bony bump on the inner side of the midfoot is tender to press. Keep your weight off that foot as much as you can, leave the exercises out, and get it checked for a fracture the same day, even if you can still walk on it.
  • Same day: you felt a pop or snap at the back of your heel or lower calf, or it felt as if someone kicked you there, even if you can still walk and push off. Stop, take the weight off that leg carefully, and go to an urgent care center or emergency department the same day, as this can be a torn Achilles tendon rather than a sprain.
  • Same day: the pain is severe and getting worse, or the swelling or bruising is very large. Get medical advice the same day.
  • Same day: the ankle or foot is hot, red and swollen, or you have a fever or feel unwell. Get medical help the same day, and go to an emergency department if you feel very unwell. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
  • Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.

Book an appointment

  • Within a week or two: the ankle keeps giving way or rolling over, even on flat ground, weeks or months after the sprain. This is not an emergency, but book an assessment with a physio or doctor in the next week or two.

Common questions

Do I have to do the exercises if I wear a brace?

The guidelines say yes, and the reason is specific rather than moralistic. A brace does not improve how well the ankle senses its own position or how steady it is, and the US physical therapy guideline states plainly that an external support should not be used on its own to improve balance and postural stability in an ankle that keeps giving way (Martin and colleagues, 2021). So the brace is the part that protects you during sport and the balance work is the part that changes the ankle, which is also why the same guideline recommends them together after a first sprain. If you are going to do one of the two, the trials put the brace ahead on sprain counts alone (Janssen and colleagues, 2014), and that is not the same as the brace being enough.

Why do I keep spraining my ankle?

Usually because the first sprain left something behind that nobody retrained. The International Ankle Consortium describes recurrence rates after a lateral sprain as high, with a large proportion of people going on to lasting instability (Gribble and colleagues, 2016), and OrthoInfo names poor balance and a previous sprain among the things that make another one more likely. The order to work through is the dull one: get the ankle bending and the calf strong, then put real work into balance on that leg, then wear a brace for the sport you keep doing it in. If the ankle is giving way on flat ground rather than in a game, that is chronic ankle instability and it is worth an assessment rather than another brace.

Tape or a brace, which should I pick?

On the evidence read for this page, either. A non-randomized trial of 157 adults compared 4 weeks of a soft brace with 4 weeks of taping and found similar numbers at one year: 13 of 76 in the brace group reported a reinjury, which is 17 percent, against 11 of 78 with tape, which is 14 percent, a risk difference of 3.1 percent (Kemler and colleagues, 2015). Because people were allocated alternately rather than at random, that is weaker evidence than a randomized trial. The practical tiebreakers are cost over a season, whether you can apply tape well enough yourself, and which one you will actually put on, since a brace in a bag protects nobody.

Do ankle support shoes or special socks help?

Not as a way of preventing sprains, and that has been tested rather than assumed. The US physical therapy guideline reports 3 randomized trials with 3,410 participants comparing low-cut with high-cut footwear, with no significant reduction in sprain risk, and it says footwear modification and orthotics have been shown to be ineffective for the general prevention of a later sprain (Martin and colleagues, 2021). Special socks are not tested at all in anything read for this page. OrthoInfo does name shoes that give the foot and ankle little support, and shoes with slippery soles, among the things that make a sprain more likely, so sensible shoes for the surface you are on still matter. Spend the money on a brace that fits your sport and on the balance work, because those are the two with trials behind them.

References

  1. Janssen KW, van Mechelen W, Verhagen EALM. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine. 2014;48(16):1235-1239. https://doi.org/10.1136/bjsports-2013-092947
  2. Bellows R, Wong CK. The effect of bracing and balance training on ankle sprain incidence among athletes: a systematic review with meta-analysis. International Journal of Sports Physical Therapy. 2018;13(3):379-388. https://pmc.ncbi.nlm.nih.gov/articles/PMC6044595/
  3. Kemler E, van de Port I, Schmikli S, Huisstede B, Hoes A, Backx F. Effects of soft bracing or taping on a lateral ankle sprain: a non-randomised controlled trial evaluating recurrence rates and residual symptoms at one year. Journal of Foot and Ankle Research. 2015;8:13. https://doi.org/10.1186/s13047-015-0069-6
  4. Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. Journal of Science and Medicine in Sport. 2015;18(3):238-244. https://doi.org/10.1016/j.jsams.2014.04.005
  5. Hupperets MDW, Verhagen EALM, van Mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009;339:b2684. https://doi.org/10.1136/bmj.b2684
  6. Martin RL, Davenport TE, Fraser JJ, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. Journal of Orthopaedic and Sports Physical Therapy. 2021;51(4):CPG1-CPG80. https://doi.org/10.2519/jospt.2021.0302
  7. Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine. 2017;51(2):113-125. https://doi.org/10.1136/bjsports-2016-096178
  8. Gribble PA, Bleakley CM, Caulfield BM, et al. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. British Journal of Sports Medicine. 2016;50(24):1496-1505. https://doi.org/10.1136/bjsports-2016-096189
  9. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. The American Journal of Medicine. 2008;121(4):324-331.e6. https://doi.org/10.1016/j.amjmed.2007.11.018
  10. NHS. Sprains and strains. Page last reviewed 23 April 2024. https://www.nhs.uk/conditions/sprains-and-strains/
  11. American Academy of Orthopaedic Surgeons. Sprained Ankle. OrthoInfo. https://www.orthoinfo.org/bodypart/foot-ankle/sprained-ankle/

Written and checked by the PocketPhysio editorial team. Last updated 2026-11-06.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.