Background <p>This systematic review and meta-analysis evaluated the effectiveness of physiotherapy compared with conventional therapies for grade I and II acute ankle sprains.</p> Methods <p>Randomized controlled trials were identified through a comprehensive search of PubMed, Embase, and Web of Science databases. Eligibility criteria were defined using the PICOS framework. Analyses included forest plot analysis, subgroup analysis, sensitivity analysis, publication bias analysis, and Trial Sequential Analysis (TSA) using Review Manager (version 5.4), StataMP 17, and TSA 0.9.5.10 beta software.</p> Results <p>Ten RCTs involving 565 participants met the inclusion criteria. The physical therapy group had significantly lower post-treatment visual analog scale (VAS) scores for pain compared to the conventional treatment group (weighted mean difference [WMD] = -0.46, 95% CI = -0.90 to -0.01, <i>P</i> = 0.04). On subgroup analysis, VAS scores at rest were also significantly lower in the physical therapy group compared to the conventional treatment group (WMD = -0.34, 95% CI = -0.67 to -0.01, <i>P</i> = 0.04).</p> Conclusions <p>Physical therapy may offer superior pain relief compared with conventional treatment for grade I and II acute ankle sprains. Further high-quality, adequately powered RCTs are warranted to obtain more robust evidence.</p> Level of evidence <p>level 1.</p> Registration <p>CRD42025640304.</p>