A sprained ankle is one of the most common sports injuries. They happen to people of all ages and physical levels. They happen when you roll, twist or turn your ankle in a weird way beyond its limits. The sprain refers to stretching or tearing the ligaments that support the ankle.
85% of ankle sprains are to the ligaments on the outside of the ankle. More than 40% of people fail to recover due to recurrent injury, instability or persistent pain. Despite this, many people regard ankle sprains as being harmless with less than half seeking medical assistance. Physiotherapy management and rehabilitation has been shown to relieve acute pain and inflammation, improve function, stability and proprioception and most importantly prevent recurrence.
What are the ligaments? They are a soft tissue structure that connect bone to bone. They function to hold the bones together and stabilise the joint. When they are stretched beyond their limit they can be injured such as the sprained ankle. There are two main groups of ligaments surrounding the ankle. The lateral group on the outside of the ankle and the medial ligament on the inside. There is also a big ligament structure between the two lower leg bones.
The lateral ligaments are the most frequently injures and there are three of them:
- the anterior talofibular ligament (ATFL)
- the calcaneofibular ligament (CFL)
- and the posterior talofibular ligament (PTFL)
The medial ligament is the deltoid ligament and is much stronger and broader than the lateral ligaments.
Injuring the ligament between the two bones - the syndesmosis - is known as a high ankle sprain and can be much more disabling and is often misdiagnosed.
What do I do if i sprained my ankle? So you have rolled your ankle and you have pain, maybe some swelling or bruising. Ice has long been recommended as part of the RICE - rest, ice compression, elevation - regimen. In 2019 there was a newspaper article suggesting ice may in fact delay healing and have a negative effect on recovery. Whilst there is limited to no evidence to support it accelerating recovery it is accepted as a reasonable intervention for short term pain reduction. By reducing pain it has the ability to enable early mobilisation and movement which can in turn accelerate recovery. As part of a complete rehabilitation approach ice can be very useful.
Acute management - the goal of acute management is to manage pain, swelling and promote early activity. Ice, taping, and physiotherapy management are all important in the early stages of recovery. Taping is used to stabilise the joint as the stabilising ligaments are then able to recover and heal. Returning to walking and functional activities as soon as able reduces injury recovery time and also reduces reinjury rates. Ice, taping and physiotherapy in the early stages facilitate this.
Rehabilitation - following an ankle ligament sprain the ankle has alterations in joint position sense, balance, muscle activation and strength, movement and neuromuscular control. Rehabilitation following injury requires addressing each of these areas in order to prevent future injury and chronic ankle sprains. Rehabilitation can start in the first week following injury and progress over subsequent weeks to return to sport or previous activity level. Exercises will include:
- local strength exercises for the muscles surrounding the ankle as well as muscles of the lower limb and trunk
- balance exercises starting with static balance and moving towards increasing the balance challenge on the ankle
- joint position sense exercises to improve your brain/ankle connection
- sport specific training including jumping, landing, cutting etc
- range of movement and stretching to restore ankle movement.
Ankle sprains may be common but they don't have to keep you off your feet or out of your sport. Rehabilitation and activity needs to start early and is best guided by a professional to get you back to where you want to be and of course prevent it happening again.
The Movement Workshop can assess and treat ankle sprains and progress your exercises according to your individual goals. Our Physiotherapists have a background working with many different sports, and Caz has a special interest in ankles.
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