An ankle sprain can feel like a temporary interruption to running.
Pain and swelling may settle within days or weeks, but the ankle may still lack the strength, balance and movement control needed for demanding running.
Quick Answer: How Can Runners Prevent Repeated Ankle Sprains?
Repeated ankle sprains can often be reduced by addressing the problems that remain after the original injury. Physiotherapy-based rehabilitation may include progressive ankle and calf strengthening, balance and proprioception training, landing control, ankle mobility work and a gradual return to running.
Runners should not rely only on pain relief or supportive footwear. If the ankle repeatedly gives way, swells after running or feels unstable on uneven ground, a physiotherapist can assess the underlying deficits and develop an individualized rehabilitation plan.
For runners, returning simply because the ankle no longer hurts can be misleading.
A previous lateral ankle sprain substantially increases the risk of another sprain, and some people develop persistent instability or repeated episodes of the ankle giving way. (Wikstrom et al., 2021)
Preventing repeated ankle sprains therefore involves more than choosing supportive shoes or resting after an injury.
A physiotherapy-led rehabilitation program can address ankle strength, mobility, balance, proprioception, landing control and running-specific function before the runner returns to full training.
Why Do Runners Keep Spraining the Same Ankle?
Most lateral ankle sprains occur when the foot suddenly moves into excessive inversion, placing stress on the ligaments on the outside of the ankle.
After the initial injury, several problems may remain even when everyday walking feels normal.
These can include reduced ankle range of motion, weakness of the calf and ankle muscles, impaired balance, reduced confidence and difficulty controlling the foot during rapid movements.
Research also shows that previous injury is an important risk factor for running-related injuries more generally.
This does not mean every runner with a previous injury will develop another one, but it highlights why rehabilitation should not stop when symptoms disappear. (Gijon-Nogueron et al., 2015)
Key Takeaways for Runners
- A previous ankle sprain increases the risk of another sprain.
- Being pain-free does not always mean the ankle has fully recovered.
- Progressive calf and ankle strengthening can help rebuild physical capacity.
- Balance and proprioception training are important components of ankle rehabilitation.
- Hopping, landing and running-specific drills can bridge the gap between rehabilitation and full running.
- Hills, trails and uneven surfaces should be reintroduced progressively.
- An ankle brace or taping may provide additional support for some runners but should not replace rehabilitation.
- Repeated ankle instability or giving way should be assessed by a physiotherapist.
When Does a Sprained Ankle Become Unstable?
Some runners continue to experience a feeling that the ankle is unstable or may “give way” after the original sprain.
This can be a sign of chronic ankle instability, particularly when symptoms persist and interfere with physical activity.
A runner may notice instability when:
- Running on uneven surfaces
- Landing after a jump
- Changing direction
- Running downhill
- Walking on uneven ground
- Performing single-leg exercises
- Increasing running speed
Chronic ankle instability is not simply a weak ankle.
It can involve a combination of mechanical, sensory and movement-control problems.
The 2021 clinical practice guideline for lateral ankle sprains and chronic ankle instability recommends assessing these impairments rather than treating every patient with the same exercise program. (Martin et al., 2021)
Why Pain-Free Does Not Always Mean Fully Recovered
Pain is an important recovery marker, but it is only one part of the picture.
A runner might be able to walk without pain but still struggle with single-leg balance, calf strength or hopping.
That difference becomes important because running repeatedly places the body on one leg and requires the ankle to absorb and redirect force quickly.
A physiotherapist therefore looks beyond pain and asks whether the ankle can perform the tasks required by the runner’s normal training.
Physiotherapy Assessment After Repeated Ankle Sprains
A physiotherapy assessment can identify why the ankle continues to be vulnerable.
Depending on the runner, assessment may include:
Ankle mobility
Restricted dorsiflexion can affect how the ankle moves during squatting, landing and running.
Muscle strength
The physiotherapist may assess calf strength as well as the muscles responsible for controlling the foot and ankle.
Single-leg control
Single-leg squats, step-downs and balance tasks can reveal movement-control deficits that are not obvious during walking.
Proprioception and balance
The ability to detect and respond to changes in foot and ankle position is important when running over unpredictable surfaces.
Hop and landing ability
Hopping provides a more demanding assessment of force absorption and dynamic control than simple standing balance.
Running-specific movement
The physiotherapist may observe running technique, changes in pace, acceleration, deceleration or direction depending on the runner’s goals.
This assessment allows rehabilitation to target the individual’s actual limitations rather than simply prescribing a standard list of ankle exercises.
Build Stronger Ankles and Calves
Strength is one of the foundations of ankle rehabilitation.
The calf muscles help control the ankle during stance and contribute to propulsion during running.
The muscles around the ankle also help control the foot when the runner lands and pushes off.
Exercises can include:
Single-leg calf raises
Rise onto the ball of one foot and lower slowly with control.
The exercise can progress by increasing repetitions, resistance or range of movement according to the runner’s capacity.
Bent-knee calf raises
Performing calf raises with the knee bent changes the muscular demand and can be useful for developing soleus capacity.
Resistance-band ankle exercises
Controlled resisted inversion and eversion can be used when weakness is identified around the ankle.
Loaded calf strengthening
Once bodyweight exercises become easy, external resistance can be introduced progressively.
The goal is not simply to complete a certain number of repetitions.
The exercise should become progressively more challenging as strength improves.
Train Balance and Proprioception
Balance training is particularly important after an ankle sprain because the ankle needs to respond quickly when the foot lands in an unexpected position.
A simple progression may begin with:
- Single-leg standing
- Single-leg standing with controlled reaching
- Single-leg squats
- Step-down exercises
- Dynamic reaching
- Hopping and landing
Balance training has demonstrated benefits for reducing ankle-sprain incidence in athletic populations.
A systematic review and meta-analysis found that proprioceptive training reduced ankle-sprain incidence compared with controls. (Vasconcelos et al., 2018)
More recent evidence also supports neuromuscular training as a useful component of ankle-injury prevention, although the available studies are predominantly in athletic populations rather than recreational runners specifically. (Xiang et al., 2026)
Progress From Balance to Running-Specific Control
Standing on one leg is only the beginning.
A runner needs to control the ankle while moving rapidly through different positions.
Once basic strength and balance have improved, rehabilitation can progress to:
- Step-downs
- Forward hops
- Lateral hops
- Single-leg landing and holding
- Repeated hops
- Skipping
- Running drills
- Acceleration and deceleration exercises
The progression should be based on movement quality.
If the ankle repeatedly rolls, the knee collapses inward or the runner cannot maintain control during landing, increasing speed or complexity may be premature.
Do Runners Need Plyometric Training?
Not every runner needs an intensive plyometric program.
However, appropriately progressed hopping and landing exercises can help bridge the gap between basic rehabilitation and the repeated impact demands of running.
A runner recovering from recurrent ankle sprains may begin with low-level hopping before progressing to multidirectional movements.
The important principle is progressive exposure, not simply performing difficult exercises as quickly as possible.
A physiotherapist can adjust the intensity according to symptoms, strength, balance and running goals.
Improve Ankle Mobility When It Is Restricted
Strength and balance are important, but mobility should not be overlooked.
Limited ankle dorsiflexion may affect the way the lower limb moves during squatting, landing and running.
A physiotherapist can determine whether restricted ankle movement is contributing to the runner’s movement pattern.
Depending on the assessment, treatment may include active mobility exercises, stretching, joint mobilisation or other manual therapy techniques alongside exercise.
Manual therapy should generally be viewed as an adjunct to an active rehabilitation program rather than a replacement for strengthening and movement retraining.
Return to Running Gradually
One of the biggest mistakes after an ankle sprain is returning directly to the previous running workload.
A runner may feel ready to jog but not be ready for the combination of distance, speed, hills and uneven terrain used before the injury.
A sensible progression may move from:
Walking → easy jogging → longer easy runs → faster running → hills → uneven or technical terrain → normal training.
The exact sequence depends on the injury and the runner’s baseline fitness.
There is no universal mileage formula that guarantees safe progression.
Instead, the ankle should be monitored for pain, swelling, instability and reduced function during and after training.
What Should Be Checked Before Full Return to Running?
Returning to running should involve more than asking whether the ankle hurts.
The PAASS framework developed by an international expert panel recommends considering five areas when making return-to-sport decisions after a lateral ankle sprain:
- Pain
- Ankle impairments
- Athlete perception
- Sensorimotor control
- Sport or functional performance
These include ankle range of motion, strength and endurance, confidence, balance, hopping, jumping, agility and the ability to complete a full training session. (Smith et al., 2021)
For runners, this framework can be adapted to the demands of their particular distance and terrain.
Do Hills and Trail Running Need Extra Preparation?
Yes, particularly after repeated ankle sprains.
Trail running can involve uneven surfaces, rocks, roots, slopes and rapid changes in foot position.
Downhill running can also increase the demand on the lower limb because the body needs to control forward movement while responding to changes in terrain.
A runner returning from ankle instability should gradually reintroduce these conditions rather than making the first trail run a test of whether the ankle is “fixed.”
Start with predictable terrain and gradually introduce more challenging surfaces as strength and dynamic control improve.
What If the Ankle Keeps Giving Way?
Repeated episodes of giving way should not simply be accepted as part of running.
They may indicate persistent ankle instability or an unresolved rehabilitation deficit.
A physiotherapist can reassess:
- Ligament-related stability
- Ankle mobility
- Calf and ankle strength
- Balance
- Proprioception
- Landing mechanics
- Running mechanics
- Confidence during movement
Persistent instability may require a more structured rehabilitation program rather than simply resting after each episode.
Can Ankle Braces or Taping Prevent Another Sprain?
External support can be useful for some runners, particularly during a return-to-sport period or when there is a history of recurrent sprains.
However, a brace or tape should not be considered a substitute for rehabilitation.
Evidence from athletic populations supports external ankle support as one possible component of prevention, while exercise-based neuromuscular training also has an important role.
The choice should be individualised based on the runner’s injury history, activity, comfort and clinical assessment.
The 2021 clinical practice guideline specifically includes external support and therapeutic exercise among strategies that may be considered for reducing recurrent injury risk. (Martin et al., 2021)
Myth vs Fact: Preventing Repeated Ankle Sprains
Myth: If my ankle no longer hurts, it is completely recovered.
Fact: Pain can improve before strength, balance, proprioception and movement control have fully recovered.
Myth: Wearing an ankle brace means I do not need rehabilitation.
Fact: Bracing or taping can provide additional support for some runners, but it does not replace strength, balance and neuromuscular rehabilitation.
Myth: Standing on one leg is enough to prevent another ankle sprain.
Fact: Static balance is only one part of rehabilitation. Runners eventually need dynamic balance, hopping, landing and running-specific control.
Myth: Every runner should follow the same ankle exercise program.
Fact: Rehabilitation should be based on the individual’s strength, mobility, balance, symptoms, injury history and running demands.
Does Every Runner Need the Same Ankle Exercises?
No.
This is an important physiotherapy principle.
One runner may have poor calf strength but good balance.
Another may have adequate strength but poor single-leg control. Someone else may have restricted dorsiflexion or persistent instability.
Giving all three runners exactly the same program may therefore be inefficient.
A physiotherapist can identify the specific impairment and choose exercises accordingly.
The program should then progress as the runner becomes stronger and more confident.
How Often Should Runners Train Their Ankles?
There is no single schedule that applies to every runner.
Strength work needs sufficient recovery, while balance and movement-control exercises can often be incorporated into regular training routines.
The most important factor is consistency.
A short, appropriately progressed program performed regularly is more useful than an intense rehabilitation session performed occasionally.
Recent research on neuromuscular training suggests that programs combining components such as strength, balance and dynamic movement can reduce ankle-injury risk in athletic populations, but the exact optimal dose for recreational runners remains uncertain. (Xiang et al., 2026)
When Should a Runner See a Physiotherapist?
A physiotherapy assessment is particularly worthwhile when:
- The ankle has been sprained more than once
- The ankle repeatedly gives way
- Running produces recurring pain or swelling
- Uneven surfaces cause instability
- The runner cannot confidently hop on the affected leg
- Calf strength is noticeably reduced
- The ankle remains stiff after the original injury
- The runner is unsure whether it is safe to return to training
- Previous rehabilitation did not prevent another sprain
Early assessment can help identify the reason for recurrence rather than treating each new sprain as an isolated event.
A Practical Ankle-Sprain Prevention Routine for Runners
A prevention program does not need to be complicated.
A runner with a history of ankle sprains can work toward including several components across the week:
Strength: Progressive calf and ankle strengthening.
Balance: Single-leg and dynamic balance exercises.
Proprioception: Exercises that challenge the ankle’s ability to respond to changing positions.
Landing control: Progressively more demanding hopping and landing exercises.
Mobility: Address restricted ankle movement when clinically relevant.
Running exposure: Gradually rebuild distance, speed, hills and uneven terrain.
Monitoring: Pay attention to recurring pain, swelling or instability.
The exact exercises, resistance, repetitions and progression should depend on the runner’s assessment and training demands.
What Is the Most Important Step After an Ankle Sprain?
The most important step is not simply getting back to running quickly.
It is completing rehabilitation before returning to the full demands of running.
Research consistently identifies previous ankle sprain as an important risk factor for subsequent sprains, while exercise-based balance and neuromuscular interventions can help address modifiable deficits.
This makes rehabilitation an important part of prevention rather than something that is only needed when symptoms are severe.
Final Thoughts
Repeated ankle sprains do not have to become a permanent part of a runner’s training history. The key is to identify what has not fully recovered and progressively rebuild it.
Physiotherapy can help address individual problems such as reduced strength, poor balance, restricted mobility, impaired movement control or difficulty with landing and running-specific tasks.
The goal is not simply to make the ankle pain-free. It is to develop the strength, mobility, sensorimotor control and confidence needed to handle the demands of running again.
Final Thoughts
Repeated ankle sprains do not have to become a permanent part of a runner’s training history.
The key is to identify what has not fully recovered and progressively rebuild it.
For one runner, that may mean improving calf strength.
For another, it may involve balance, ankle mobility, landing control or confidence during single-leg movement.
Physiotherapy can help identify these individual deficits and build a progression from basic exercises to running-specific tasks.
The goal is not simply to make the ankle pain-free.
It is to develop enough strength, mobility, sensorimotor control and confidence for the ankle to handle the demands of running again.
With appropriate rehabilitation and a gradual return to running, runners can reduce modifiable risk factors and build greater confidence in the injured ankle.
Frequently Asked Questions About Repeated Ankle Sprains in Runners
1. Why do I keep spraining the same ankle when running?
A previous ankle sprain can leave deficits in strength, balance, proprioception, mobility or movement control. These factors may contribute to recurrent instability, particularly during uneven terrain, landing or rapid changes in movement.
2. Can strengthening exercises prevent repeated ankle sprains?
Progressive strengthening is an important part of ankle rehabilitation. It can help improve the capacity of the calf and ankle muscles, although prevention usually involves more than strengthening alone and may also include balance and neuromuscular training.
3. How important is balance training after an ankle sprain?
Balance training is an important component of rehabilitation because runners need to control the ankle while standing and moving on one leg. Training can progress from static balance to dynamic movements, hopping and running-specific tasks.
4. Can I run if my ankle still feels slightly unstable?
Persistent instability should not be ignored. A physiotherapist can assess whether the ankle has sufficient strength, balance and movement control for the intended running workload and guide a gradual return to running.
5. Are ankle braces useful for runners with previous sprains?
An ankle brace may provide additional support for some runners, particularly during higher-risk activities or return to sport. It should be considered alongside rehabilitation rather than as a replacement for exercise.
6. When should I see a physiotherapist for repeated ankle sprains?
A physiotherapy assessment is appropriate when the ankle repeatedly gives way, pain or swelling keeps returning, running remains uncomfortable, or the ankle feels unstable on uneven surfaces.
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Medical Disclaimer
This article is intended for general educational purposes and should not be considered a substitute for an individual assessment by a qualified physiotherapist or healthcare professional. Exercise selection and progression should be based on the person’s injury history, symptoms, physical capacity and running demands. Seek professional medical assessment if ankle pain is severe, swelling persists, the ankle repeatedly gives way, or symptoms are worsening.
