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How Is a Sprained Ankle Graded?

How Is a Sprained Ankle Graded?

At Sports Medicine Oregon in Tigard and Wilsonville, Oregon, we evaluate and treat acute joint injuries on a routine basis — some are sports-related mishaps or the result of an accidental fall, while others are a slowly developing product of repetitive stress or strain. 

For many people who arrive at our offices with painful ankle injuries, a thorough examination often leads to a very common diagnosis: ligament sprain. Learn the ins and outs of this frequent joint injury, including how it’s graded for severity.   

Understanding ankle sprains

An ankle sprain is an acute injury that affects one or more of the ligaments that support and stabilize the joint. Ligaments are flexible, fibrous bands of connective tissue — a lot like super-strong rubber bands — that connect one bone to another and bind the joint together. 

Your ankle joint has several ligaments, including three major ones on the outside of the ankle that comprise its lateral ligament complex. These vital bands of tissue allow for normal motion and restrict excessive movement, particularly extreme side-to-side motion.

A sprain occurs when one or more ligaments are overstretched or torn, usually because of a sudden, twisting movement or an intense impact. A sprain shouldn’t be confused with a strain, which affects muscles rather than ligaments.  

The most common sprain injury

While any joint can sustain a sprain injury, weight-bearing and high-use joints are more susceptible. Ankle sprains are most common, followed by knee, wrist, thumb, and elbow sprains. A sprained ankle is usually caused by one of the following: 

Sports injury

As one of the leading sports injuries, sprained ankles tend to occur during high-impact activities that require quick directional changes (tennis, basketball, football, and soccer). 

Repetitive stress 

Repetitive joint stress (overuse) increases the risk of sustaining a sprained ankle in the game; improper biomechanics (poor form) and lack of conditioning can make a sports-related ankle sprain more likely, too.  

Impact injury

An ankle sprain can also occur when a sudden impact (fall, collision accident) forcefully twists or briefly bends the joint into an unnatural position.


An overextension injury isn’t always caused by a sudden impact — sometimes, all it takes is a simple misstep to overextend the ligaments in your ankle joint and sustain a sprain.

Ankle sprain diagnosis and grading

All ankle sprains generate five main symptoms, each of which can vary in intensity depending on the extent and severity of the injury:  

Using a simple grading system, ankle sprains are categorized as mild, moderate, or severe based on the degree of trauma and number of ligaments involved. Damage and symptoms are worse — and treatment needs more involved — with each progressive grade level: 

Grade I sprain 

A mild Grade 1 sprain occurs when an ankle joint ligament becomes overstretched and/or sustains minor, microscopic tears. Manageable pain, mild swelling, and slight joint stiffness are normal; bruising isn’t common.  

Grade 2 sprain 

A moderate Grade 2 sprain means one or more of the stabilizing ligaments in your ankle joint have sustained significant partial tears. This level of trauma is more likely to cause bruising, continuous pain, and swelling that makes it difficult to move your ankle.    

Grade 3 sprain 

A severe Grade 3 ankle sprain occurs when a ligament tears all the way through or ruptures, resulting in a complete loss of joint stability and integrity. Immediate, severe pain and swelling are common; you may also hear a “pop” when it happens. Bruising often appears later.

Ankle sprain care and recovery

If you suspect you’ve sprained your ankle, start immediate self-care with the “PRICE” approach: protection, rest, ice, compression, and elevation. These strategies help alleviate pain, reduce swelling, and protect your injured joint until you can get a proper diagnosis and expert care.

To ensure complete, efficient healing, it’s important to see an orthopedic specialist as soon as possible. A moderate or severe sprain may require you to use crutches, wear a brace, undergo a surgical repair, or all the above. Afterward, physical therapy can help you regain full joint strength, stability, and motion. 

If you have a painful joint injury, we can help. Call your nearest Sports Medicine Oregon location in Tigard or Wilsonville today, or use the easy online booking tool to schedule a visit with one of our experienced orthopedic experts any time.   

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