Ankle sprains are one of the most common sporting injuries seen by healthcare professionals. They also tend to be one of the most repetitive. We all know that player on the team who has perpetually strapped ankles, and that will hobble off the field at least once every season.

So what happens when you sprain your ankle and what makes some ankles more susceptible to injury than others? Why do some people seem to recover faster than others, and not go on to have long term problems?

The ankle joint is comprised of the mortise formed by the ends of the lower leg bones (tibia and fibula), and the talus, a dome shaped wedge of bone. Together they act somewhat like a hinge for the foot. The joint is surrounded by a capsule like the other synovial joints, and ligaments re-enforce this. It is typically the ligaments that bear most of the damage when the ankle is twisted too far.

ankle-sprain-anat02.jpg

There are also some important ligaments at the bottom of the lower leg that can be injured. They are often referred to as the syndesmosis, and are the structures injured in a "high" ankle sprain.

ankle_syndesmosis_anat04.jpg

The vast majority of ankle sprains (more than 95%) are Inversion Sprains. These occur when the  ankle rolls and the foot twists under you. They are more prevalent as the ligaments on the outside of the ankle are smaller than the ones on the inside. Syndesmosis injuries are more common than medial ankle sprains, and are linked to longer term pain, later return to sport and re-injury.

Ankle sprains are assessed on their severity by how badly damaged the ligaments are. This is usually assessed by feeling for looseness in the ankle. Sometimes radiology can be used to help assess the ankle for other injuries. How severe the sprain, and therefore how much bruising and swelling there are will have a significant effect on how quickly someone can return to activity. Simple sprains may only need a few weeks rest, however is some cases people report pain and instability for 6 months or more post injury.

Assessment of your ankle by an experienced physiotherapist or doctor is important to determine both the severity of the injury, and to ensure there are no significant problems that may need further investigations, like a fracture. Sometimes severe ankle sprains can only be corrected by surgery (Although this is usually only looked at if conservative rehab has failed).

Early management of an ankle sprain is fairly consistent, regardless of severity. The subsequent stages of rehabilitation will be moved through at a rate determined by the severity of the injury. Healing and return to activity will be optimised by paying attention to the following stages of recovery.

Stage 1 - Rice

Good old Rest - Ice - Compression - Elevation. In terms of rest, severe ankle sprains should spend a couple of days on crutches, or until you can weight bear without too much pain. Simple elastic bandages will provide good compression. Occasionally a severe sprain may be put into a moon boot. This protects the injury and helps improve mobility by reducing pain.

Stage 2 - ROM/Flexibility Exercises

Early movement is very helpful for joint sprains. Even if a period of immobility is needed post injury, range of movement exercises will be one of the first things you commence. These will include both exercises to move the joint and exercises to stretch the muscles.

Stage 3 - Strengthening Exercises

While the ankle joint is painful and swollen, the muscles in that area become weakened, and need to be strengthened again to allow normal movement to return. Some of these muscles are to provide power to the foot and ankle, e.g. the calf. Other muscles like the peroneals contribute both strength and stability to the ankle. Rehabilitation of these muscles is crucial to help prevent re-injury.

Peroneal Muscles

Peroneal Muscles

Calf muscles

Calf muscles

Stage 4 - Proprioception and Balance Exercises

Balance exercises help retrain the normal reflex reactions of the ankle to sudden load or stress, from changing direction or from stepping on uneven ground. You have felt these systems at work if you have experienced a "near miss" ankle sprain. This is when you can feel the ankle starting to roll, but it suddenly pops back underneath you. Reflex muscle actions in the leg are responsible for correcting your position automatically. It is imperative to retrain these systems after injury to reduce the likelihood of re-injury.

Stage 5 - Agility and Endurance

In this stage you will start to perform more athletic exercises designed to restore your agility and strength for return to sport or activity. Sometimes there are Sport Specific exercises that may be performed to prepare you for specific activities.

Stage 6 - Return to Sport

In the return to sport phase you will steadily return to normal training and playing. Normally your physiotherapist will guide you back through different intensities of training skill ranges to ensure a safe return. They may also give you advice regarding taping and bracing of your ankle to give it extra support when you return to sport. You can read more about the differences between taping and bracing in our earlier post on the topic here.

If you would like your ankle injury expertly assessed and receive the best advice for return to sport, book an appointment with one of our Physiotherapists today. Go to our Online Bookings page or call us on 07 3350 2596.