I sprained my ankle 4 – 5 weeks ago. I have no pain at rest or during daily activities, full range of motion (ROM) in the injured ankle, and greater than 90% of the strength/function, but there is still slight pain (about 2 out of 10) during functional tests (e.g., hop test).

Is this normal despite full ROM and decent symmetry? Why is this pain still present despite improved ROM and strength?

Thank you,

– Alex


Hi Alex,

Thank you for reaching out and I’m sorry to hear of your ankle injury. Without doing an examination I’m not able to comment at length on your specific condition and what you’re experiencing, but there are some general principles we can discuss. While some ankle sprains may have a rapid decrease in pain and improved motion within the first two weeks after the injury, some may take longer. Not all ankle sprains are the same and they can vary significantly in the amount of swelling, pain, range of motion (ROM) limitations, and overall level/loss of function. This wide degree of variance is because although we typically associate an ankle sprain with disruption to the ligaments of the ankle, other structures such as muscles, tendons, joints, and bones can be impacted as well.

This is the type of thing a Physical Therapist would identify during an examination to better tailor a rehabilitation program.
Nevertheless, in the event of an ankle sprain the primary structure involved would be a ligament, a structure that connects bones to other bones and thus contributes to stability. It may be helpful to think of rehabilitation of ankle sprains in terms of phases. Generally speaking, in the event of an ankle sprain our initial rehab goals are to minimize swelling and pain, followed by improving ROM and strength. The next phase of rehab would focus on having little-to-no pain during daily activities, so if you’re currently having no pain during daily activities and you feel that your range of motion and strength are near normal that is a really good sign.

The next phase of rehab would focus on more challenging functional tasks including plyometric activities. This is where a series of hop tests (single hop test, triple hop test, etc.) can be helpful in determining your capability of returning to sports or higher-level activities, and having some pain during these types of tests may indicate that there’s still some progress to be made in the rehabilitation process. The point being that having improved/near normal levels of ROM and strength don’t necessarily translate to improved functional performance as this is a separate element of rehabilitation that may require intentional training.

If you continue to experience pain with functional and/or athletic activities I encourage you to reach out to be evaluated by a Physical Therapist to better identify what may be contributing to your pain and accordingly intervene.

**This reply is for informational purposes only. It’s not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, physical therapist, or other qualified health provider with a medical condition.