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Why Does Ankle Pain Linger After a Sprain?

Introduction: When a Simple Sprain Becomes a Chronic Problem

Ankle sprains are among the most common injuries in both sports and daily life. The typical recovery path is straightforward: rest, ice, gradual movement, strengthening, and a return to normal activity. For many, this process works well.

But what if your ankle pain doesn’t go away? Many people experience persistent pain and stiffness after an ankle sprain, even after visiting a doctor, going through physical therapy, and performing standard foot exercises. These unresolved cases often progress into chronic ankle instability (CAI)—a condition that affects movement, balance, and long-term performance.

While early strengthening and mobility exercises are crucial, they are not always enough. In some cases, the ankle joint itself requires realignment or movement correction before exercises can be truly effective. Without this, rehabilitation may stall—or even make the problem worse.

What Happens Inside the Joint After a Sprain?

Research has shown that ankle sprains can leave behind more than just pain. In chronic ankle instability:

  • Bone alignment changes occur: Studies show significant anterior displacement and internal rotation of the talus bone following CAI.
  • Walking mechanics are altered: People with both acute ankle sprains and CAI display increased rearfoot inversion during walking, with CAI cases showing more persistent inversion across most of the stance phase.
  • Joint stiffness develops: Imaging evidence demonstrates anterior shifts of the talus or fibula relative to the tibia in chronic sprains, which can restrict ankle motion and create long-term stiffness.

These findings suggest that unresolved joint malalignment may be the hidden culprit behind ongoing pain and limited progress in rehab. If your therapy program focuses solely on repetitive exercises without correcting these underlying issues, you may not be addressing the root of the problem.

Ankle Sprain
Mobilization with Movement

Beyond Exercise: The Role of Mobilization with Movement (MWM)

Strengthening exercises are critical in recovery, but they often need to be paired with manual therapy techniques like Mobilization with Movement (MWM) to restore proper joint mechanics.

The evidence strongly supports MWM:

  • A systematic review of 10 trials with 419 patients found MWM significantly reduced pain and improved ankle range of motion compared to controls.
  • Randomized controlled trials show that MWM outperforms placebo treatments and traditional mobilization methods.
  • Over 80% of patients respond positively when MWM is applied to improve weight-bearing dorsiflexion.
  • Case series highlight immediate functional gains in competitive athletes.
  • Long-term outcomes favor distal fibula MWM over other manual therapies for restoring both daily and sports activities.

In practice, the exact MWM technique depends on the specific joint restriction or malalignment, making skilled assessment by a physical therapist essential.

Conclusion: Key Takeaways for Ankle Sprain Recovery

Ankle sprains may seem simple, but lingering pain and instability can signal deeper joint issues. Joint malalignment, stiffness, and altered mechanics often persist unless properly addressed. While exercise remains important, evidence shows that mobilization with movement can be the missing piece for restoring function and preventing chronic ankle problems.

So if your ankle pain isn’t improving with standard rehab, consider whether your program is addressing the joint itself—not just the muscles. A skilled physical therapist can help realign movement, restore function, and get you back to full activity with confidence.

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< Reference >

  • Kobayashi, Takumi, Yuta Koshino, and Takahiro Miki. “Abnormalities of Foot and Ankle Alignment in Individuals with Chronic Ankle Instability: A Systematic Review.” BMC Musculoskeletal Disorders 22, no. 1 (2021): 683. https://doi.org/10.1186/s12891-021-04537-6.
  • Fraser, John J., Joseph M. Hart, Susan F. Saliba, Joseph S. Park, Marshall Tumperi, and Jay Hertel. “Multisegmented Ankle-Foot Kinematics during Gait Initiation in Ankle Sprains and Chronic Ankle Instability.” Clinical Biomechanics 68 (August 2019): 80–88. https://doi.org/10.1016/j.clinbiomech.2019.05.017.
  • Nguyen, Anh Phong, Laurent Pitance, Philippe Mahaudens, et al. “Effects of Mulligan Mobilization with Movement in Subacute Lateral Ankle Sprains: A Pragmatic Randomized Trial.” Journal of Manual & Manipulative Therapy 29, no. 6 (2021): 341–52. https://doi.org/10.1080/10669817.2021.1889165.
  • ElMeligie, Mohamed M., Heba A. Abdeen, Hady Atef, Elena Marques-Sule, and Rania N. Karkosha. “The Effectiveness of Mulligan Mobilization with Movement (MWM) on Outcomes of Patients with Ankle Sprain: A Systematic Review and Meta-Analysis.” BMC Sports Science, Medicine and Rehabilitation 17, no. 1 (2025): 105. https://doi.org/10.1186/s13102-025-01121-6.
  • Gogate, Neha, Kiran Satpute, and Toby Hall. “The Effectiveness of Mobilization with Movement on Pain, Balance and Function Following Acute and Sub Acute Inversion Ankle Sprain – A Randomized, Placebo Controlled Trial.” Physical Therapy in Sport 48 (March 2021): 91–100. https://doi.org/10.1016/j.ptsp.2020.12.016.
  • Norouzi, Adeleh, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani, and Rasool Bagheri. “A Comparison of Mobilization and Mobilization with Movement on Pain and Range of Motion in People with Lateral Ankle Sprain: A Randomized Clinical Trial.” Journal of Bodywork and Movement Therapies 27 (July 2021): 654–60. https://doi.org/10.1016/j.jbmt.2021.05.006.
  • Weerasekara, Ishanka, Hayley Deam, Nathan Bamborough, et al. “Effect of Mobilisation with Movement (MWM) on Clinical Outcomes in Lateral Ankle Sprains: A Systematic Review and Meta-Analysis.” The Foot 43 (June 2020): 101657. https://doi.org/10.1016/j.foot.2019.101657.
  • May, James M., Alan Nasypany, Julie Paolino, Russell Baker, and Jeffrey Seegmiller. “Patient Outcomes Utilizing the Mulligan Concept of Mobilization With Movement to Treat Intercollegiate Patients Diagnosed With Lateral Ankle Sprain: An a Priori Case Series.” Journal of Sport Rehabilitation 26, no. 6 (2017): 486–96. https://doi.org/10.1123/jsr.2015-0204.
  • Hudson, Robinetta, Russell T. Baker, James May, Don Reordan, and Alan Nasypany. “Novel Treatment of Lateral Ankle Sprains Using the Mulligan Concept: An Exploratory Case Series Analysis.” Journal of Manual & Manipulative Therapy 25, no. 5 (2017): 251–59. https://doi.org/10.1080/10669817.2017.1332557.
  • Izaola-Azkona, Loitzun, Bill Vicenzino, Iratxe Olabarrieta-Eguia, Marc Saez, and Ion Lascurain-Aguirrebeña. “Effectiveness of Mobilization of the Talus and Distal Fibula in the Management of Acute Lateral Ankle Sprain.” Physical Therapy 101, no. 8 (2021): pzab111. https://doi.org/10.1093/ptj/pzab111.

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