If you closely follow sports and are actively involved in fantasy sports leagues, you are all too familiar with players being sidelined by ankle sprains—especially high ankle sprains. Even so, many people aren’t aware that the location of the sprain is an essential factor in both the treatment of the injury and the recovery timeline.

Generally speaking, there are three types of ankle sprains. The most common are lateral ankle sprains, which occur on the outer, or lateral ligaments, of the ankle. Medial ankle sprains occur on the ligaments of the ankle’s inner side. High ankle, or syndesmotic ankle, sprains injure ligaments between the two bones of the lower leg and can cause a separation of those bones, if severe. If high ankle sprains sound more complicated than other ankle sprains, that’s because they are. So, it’s essential to understand the approach to treating them.

With a high ankle sprain, there is more extensive damage to more structures. In the lower part of the leg, there are two bones: the tibia and the fibula. Between them is a membrane of connective tissue that keeps the two bones together. A high ankle sprain involves not only injury to those ankle ligaments, but also a forceful separation between the tibia and fibula.

High ankle sprains often occur in football, when a player plants a foot and tries to push off or change directions quickly, or is struck by another player who has been blocked or tackled to the ground.

The chief symptom of a high ankle sprain is pain that radiates up the leg from the ankle. Every step taken on this type of sprain can be very painful, and the severity may increase when moving the foot in the direction in which the sprain occurred.

Although high ankle sprains are a severe injury, they don’t often cause significant swelling or bruising. Due to the lack of visible signs of injury, this type of sprain can be frustrating for an athlete because the ankle “looks fine.” In these cases, there is a danger of athletes carrying on as usual and playing through pain because they might not realize the extent of the injury.

During a doctor’s examination and diagnostic process, ankle sprains can be graded between 1 and 3 based on the severity of the injury. A Grade 1 ankle sprain, or mild sprain, means that there is some minor stretching or tearing of the ligaments, but they remain entirely intact.

A Grade 2, or moderate sprain, involves partial tearing of the ligament. A Grade 3, or severe sprain, means the ligament is completely ruptured, and all of the fibers are torn. Typically, the higher the grade for any ligament sprain, the longer the recovery. Also, the higher the grade, the more likely surgical correction will be required, depending on the level of sport or activity that the injured person wants to resume.

Read: How to Treat an Achilles Tendon Tear

The standard treatment for high ankle sprains, especially in the acute period after the injury, is called the RICE protocol. “R” stands for rest, keeping weight off of the injured ankle. “I” stands for ice, applying it every 20 to 30 minutes for the first couple of days after injury. “C” stands for compression, the wrapping of the ankle to minimize swelling. “E” stands for elevation, keeping the affected leg elevated to reduce pain and swelling. Physical therapy is also crucial after an ankle sprain to restore range of motion and to strengthen the ankles and leg muscles as well as regain balance to help prevent re-injury.

Most high ankle sprain cases will begin with nonsurgical treatment. But when surgery is needed, it might involve the placement of a screw or strong suture material between the tibia and fibula to hold the bones together. This procedure helps to relieve ligament pressure while healing continues.

The recovery time for a high ankle sprain varies greatly from athlete to athlete. In some situations, an athlete can return to the sport in four to six weeks, but in cases where the injury is more extensive or surgery is required, that timeline can be pushed out to at least six to 12 months for a full recovery. Following surgery, and once the surgeon determines there are no longer any activity restrictions, post-surgical rehab begins.

The best way to prevent ankle sprains is to be proactive about working on balance as well as strengthening the hips, core and ankles. A number of athletes also choose to wear ankle braces or tape while they play, which may help if it is done along with muscle strengthening. Not all sprains can be prevented, but with the help of a certified medical specialist or a physical therapist, you can help minimize your risk.