Ankle sprains account for up to 30% of all sports injuries (1). When the ankle joint is put under strain from sudden twisting forces or landing in an uneven position it causes too much stress on the supportive ligaments, resulting in a tear. More commonly seen in sports with lateral movement and jumping, such as basketball or volleyball. But everyday life, misjudging steps or walking on uneven ground.
- Severe pain
- Difficulty walking
- Loss of balance
What structures get damaged?
The ankle consists of 3 bones, the Tibia, Fibula and Talus. Depending on the force from the injury we can have fractures of the tibia and fibula. 25% of ankle sprains could have some form of fracture (2), whether it be a complete break, a chip of the bone or the ligament pulling the bone from its attachment. An Xray would help eliminate this diagnosis and help guide your rehab.
The ankle is the pivot point for the foot and the leg, it gives us a range of different movements. We have ligaments aligning in various directions to provide support for the ankle. When movement is taken too far ligaments can be damaged. On the outer part of the ankle we have 3 ligaments, the inner part has a large dense ligament and the tibia and fibula have connecting ligaments.
An ankle sprain can have more than one ligament involved, but the most common ligament to get strained is the Anterior Talo-Fibila Ligament (ATFL), affected by up to 73% of ligament injuries (3). Most commonly brought on from rolling the ankle.
The degree of damage to ligaments is classified by grades 1-3. Grade 1 meaning small tears of the ligament fibers, Grade 2 a partial tear of the ligament between 10-90% and grade 3 being a complete rupture. All grades have different recovery times and need to be guided appropriately for the best outcome.
Management of my ankle sprain
In the first 72 hours you will go through the first stage of healing. During this time you want to move the ankle within your comfort level, don’t push into sharpness. Compress and elevate the joint to manage the swelling. If you wish to use ice (5 minutes minimum) and NSAID’s, use it sparingly only to control the pain. See my blog about ice for more info.
Diagnosing an ankle sprain and rehab
If you have sprained an ankle it’s important that you are assessed by a Dr or Physiotherapist. Taking a detailed history and clinically assessing your ankle will help us come to a clear diagnosis of your injury. Xrays and ultrasound scans may also be required.
Someone that sprains their ankle is 5 times more likely to sprain their ankle again (4)
Once we understand the severity of the injury, treatment can be more specific to achieve the quickest recovery. Physio can assist in number of ways:
- Education – Understanding the tissue recovery, the mechanics of the ankle, knowing your treatment plan and the stages of your rehab.
- Gait re-training – You may start off on crutches or a moonboot, but then weaned off and guided to walk normally.
- Exercise prescription including sport specific training – As you improved you will be provided the appropriate exercises. Including exercises relating you your sport to make a better transition.
- Balance exercises – Progressing balance is essential to preventing further ankle sprains.
- Taping – There are a number of strapping techniques for swelling/bruising in the initial stage. Strapping can ease you back safely into sport.
- Soft tissue massage – This helps stimulate blood flow and encourage healing. Also, helps desensitise the nervous system to encourage better movement.
- Mobilisations – to assist in better movement of the joint and gives you more confidence to use it.
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- Fong et al, (2007)A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007
- Luciano et al, (2012) Epidemiological study of foot and ankle injuries in recreational sports. Acta Ortop Bras
- Woods et al, (2003) The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains. A Br J Sports Med.
- McKay et al, (2001) Ankle injuries in basketball: injury rate and risk factors. Br J of Sports Med.