Ankle sprains are very common, in fact they are the most common of all athletic injuries, accounting for up to 25% of all lost to injury time in sports. The most common type of ankle sprains, up to 90%, involve the lateral ligament complex. This is made up of 3 ligaments on the outside of the ankle and they are usually damaged by a combination of plantar flexion and inversion, which is when the ankle rolls inwards with the toes pointed. The classic mechanism for this would be an uncontrolled landing from a jump but it can also happen in everyday life with seemingly innocuous movements such as stepping off a kerb, into a hole or a simple trip or fall.
The most frequently injured ligament is the ATFL which makes up around 70% of ankle sprains, then the CFL & PTFL. Though less frequently seen, the thick broad deltoid ligament on the inside of the ankle can also be sprained. The mechanism for this is forced eversion of the ankle, where the foot is rotated up and out, normally with high or an external force. It is also possible to have a high ankle or syndesmosis sprain with this mechanism. The syndesmosis is the ligament that runs between the two lower leg bones (tibia & fibula). Deltoid ligament or syndesmosis sprains are fairly rare but tend to more serious, taking on average twice as long to heal.
All ligament sprains are classified as either grade 1 (mild),2 (moderate) or 3 (severe) depending on the damage to the ligamentous and capsular structures and the degree of instability and functional loss. Some of the common symptoms of an ankle sprain are listed below:
The early management of an ankle sprain is crucial to a good recovery. If there is tenderness over the bones around the ankle, or you’re unable to weight-bear at all, it’s important you see a Physiotherapist to rule out any potential fractures or serious injuries that may require imaging or onward referral. Once that has been ruled out, early treatment will aim to reduce the swelling and inflammation and you should also follow the PRICE principles below:
P = Protection
Aim to prevent further injury. This may be done through rest (see below) or even immobilising the area with a taping or bracing
R = Rest
Avoid any aggravating activity. This may include walking in the first 48 - 72hours where crutches may be required. This rest will allow the healing process to begin.
I = Ice
Applied for up to 20mins at a time ice will help reduce inflammation and prevent further bleeding
C = Compression
Usually achieve with an elasticated or wrap bandage, this will also help prevent further swelling.
E = Elevation
Will help reduce blood flow to the area in the acute phase to help prevent further bleeding. Elevation will also help swelling and other fluid drain from the affected area reducing pain.
After the acute period, your physiotherapist will then commence range of movement exercises followed by strengthening and neuromuscular balance and proprioception work.
Recurrent / Chronic Ankle Instability
From 6-8weeks post injury, depending on the severity, it is common for pain to have settled. Unfortunately, many people believe this means their problem is completely fixed and return to their previous activities without completing their rehab. Due to this inadequate management, studies show that following an ankle sprain, 40% of people suffer a recurrence. This happens because of a combination of factors including stretching of the damaged ligaments, muscle weakness around the ankle, reduced proprioception and disruption of the normal neurological pathways. Early diagnosis and a comprehensive, functional treatment and rehabilitation program are the keys to preventing chronic ankle instability.
For assessment of your ankle injury, whether acute or chronic, call today to book an appointment with one of our expert physiotherapists.