An ankle that repeatedly rolls, feels unsteady or unexpectedly “gives way” can become frustrating, particularly when the original ankle sprain happened months or even years ago.
For some people, these recurring symptoms may be associated with chronic ankle instability — a condition that can develop following one or more ankle sprains and may affect balance, confidence and the ability to participate comfortably in sport or everyday activities.
The good news is that ankle instability is not necessarily something you simply have to accept. A structured rehabilitation programme can focus on restoring strength, balance, movement control and confidence in the ankle.
What Is Chronic Ankle Instability?
Chronic ankle instability generally refers to ongoing feelings of instability or repeated episodes of the ankle giving way following previous ankle sprains.
Some people experience another obvious ankle roll, while others notice subtler symptoms such as:
- Feeling unsteady on uneven ground
- Difficulty balancing on one leg
- Reduced confidence during sport
- Repeated minor ankle rolls
- Discomfort during running or jumping
- Difficulty changing direction quickly
- A sense that the ankle cannot be fully trusted
Symptoms can vary significantly between individuals.
Chronic ankle instability is therefore not simply defined by how the ankle looks. It can involve changes in strength, balance, joint movement and neuromuscular control following injury.
Why Can Instability Persist After an Ankle Sprain?
An ankle sprain commonly involves damage to the ligaments that support the joint.
Although pain and swelling may improve, other physical changes can persist.
For example, some people may have ongoing limitations in ankle movement, reduced strength around the foot and lower leg or difficulty responding quickly when the ankle moves unexpectedly.
The nervous system also plays an important role.
Information from muscles, tendons and joints helps the body understand where the ankle is positioned. After an ankle injury, this sensorimotor system can sometimes become less effective, which may contribute to poorer balance or slower reactions.
This is one reason why simply waiting for pain to disappear does not always fully restore ankle function.
Balance Is an Important Part of Ankle Control
Balance training is commonly included in rehabilitation for chronic ankle instability.
Clinical guidance published in the Journal of Orthopaedic & Sports Physical Therapy recommends proprioceptive and neuromuscular therapeutic exercise for people with chronic ankle instability to improve dynamic postural stability and perceived stability during movement.
You can read the clinical practice guideline on ankle instability and lateral ankle sprains for a detailed review of the evidence.
Balance exercises may begin relatively simply.
For example, standing on one leg may initially provide enough challenge. Rehabilitation can then progress by changing the surface, introducing reaching movements, adding resistance or incorporating movements that more closely resemble sport.
The goal is to progressively challenge the body’s ability to control the ankle rather than simply trying to remain still for longer periods.
Strengthening the Foot, Ankle and Lower Leg
Muscular strength also contributes to ankle stability.
Rehabilitation may therefore include exercises targeting the muscles surrounding the ankle, foot and lower leg.
Depending on the individual’s presentation, exercises might include:
- Calf raises
- Resistance-band exercises
- Single-leg strengthening
- Foot strengthening
- Squats and lunges
- Step exercises
- Controlled hopping or landing drills
As rehabilitation progresses, strength exercises can increasingly resemble the activities a person wants to return to.
Someone who mainly wants to walk comfortably on trails will have different requirements from a basketball player who regularly jumps, lands and rapidly changes direction.
The Role of the Hip and Knee
Ankle control does not occur in isolation.
Movement at the hip and knee influences how forces travel through the lower limb during activities such as walking, running, landing and cutting.
For this reason, a rehabilitation programme may also include exercises addressing strength and movement control above the ankle.
This broader approach can be especially relevant for people returning to sports that require rapid acceleration, deceleration or changes of direction.
Ankle Mobility May Also Matter
Restricted ankle movement can sometimes remain after an ankle sprain.
In particular, limitations in dorsiflexion — the movement that brings the shin forward over the foot — may influence activities such as squatting, descending stairs, running and landing.
Mobility exercises can therefore form another part of ankle rehabilitation.
Manual therapy may also be used when appropriate. Techniques can include joint mobilization, stretching and soft-tissue treatment, alongside active exercise rehabilitation.
Current clinical guidance supports the use of certain manual therapy techniques for short-term improvements in ankle dorsiflexion and dynamic balance in people with chronic ankle instability.
However, hands-on treatment is generally only one component of rehabilitation rather than a substitute for strengthening and balance work.
Do Ankle Braces Solve the Problem?
Braces and taping can provide additional external support in some situations.
Athletes, for example, may temporarily use external ankle support when returning to activities that involve a high risk of rolling the ankle.
However, external support alone does not necessarily address the underlying physical factors associated with instability.
Clinical practice guidelines specifically advise against using bracing or taping as the sole intervention for improving balance and postural stability in chronic ankle instability.
Instead, they may be considered as part of a broader rehabilitation strategy when appropriate.
Returning to Running and Sport
A successful return to sport involves more than being able to walk without pain.
The ankle needs to tolerate progressively greater demands.
Rehabilitation may therefore advance through activities such as:
Walking → strengthening → balance training → jogging → running → jumping → landing → changes of direction → sport-specific drills.
Progression should be based on the individual’s symptoms, control and physical ability rather than simply the number of weeks since the original injury.
Testing balance, strength and functional movements can also help identify areas that may need further rehabilitation.
When Should Repeated Ankle Instability Be Assessed?
Occasionally rolling an ankle does not necessarily indicate chronic ankle instability.
However, professional assessment may be worthwhile when:
- The ankle repeatedly gives way
- You have experienced several ankle sprains
- You avoid certain activities because you do not trust the ankle
- Balance remains noticeably poorer on one side
- You continue to experience pain or swelling
- Ankle mobility remains restricted
- Previous rehabilitation has not resolved the problem
An assessment can help determine which factors may be contributing to the symptoms and guide an appropriate treatment plan.
For people seeking ankle instability treatment in Vancouver, Northwest Rehab Group provides individualized assessment and rehabilitation through its multidisciplinary clinic in Mount Pleasant.
NRG’s approach can incorporate exercise rehabilitation alongside manual therapy, including mobilizations, stretching, soft-tissue techniques and other modalities where clinically appropriate. The clinic also emphasizes personalized treatment rather than relying on a single treatment technique.
Building Confidence in the Ankle Again
Chronic ankle instability can affect more than the ankle itself.
People who have repeatedly rolled an ankle may naturally begin protecting it, slowing down during sport or avoiding movements they no longer trust.
A well-structured rehabilitation programme therefore aims not only to improve physical measures such as strength and balance but also to progressively restore confidence during real-world movements.
That might mean walking comfortably over uneven ground, returning to running, hiking on Vancouver’s trails or participating confidently in competitive sport.
The underlying principle is straightforward: rehabilitation should gradually prepare the ankle for the activities you actually want it to perform.
Rather than focusing solely on whether the ankle still hurts, successful rehabilitation considers how well it moves, responds and functions when placed under increasing demands.