Ankle Sprains

Ankle sprains are a very common lower limb injury. Around 5% of annual visits to Emergency Departments in Australia are for ankle sprains, and they are estimated to make up about 15% of all sports injuries.

Ankle injuries occur when excessive forces push an ankle joint into excessive movement that soft tissues cannot tolerate and are subsequently injured. The most common ligament injured in an ankle sprain is the Anterior Talofibular Ligament (ATFL).

There are some proven risk factors that are associated with ankle sprains.

• Previous or existing ankle injury especially if poorly rehabilitated (biggest risk factor).
• Lack of strength and stability related to the ankle.
• Lack of, or extreme flexibility, in the ankle joint.
• Poor balance.
• Sudden change in direction (acceleration or deceleration).
• Increasing age of player.

There are also some suspected risk factors

• Poor condition of the playing surface.
• Inappropriate, inadequate, or no warm-up.
• Wearing inappropriate footwear for the activity.
• Lack of external ankle support (taping, bracing) for previously injured ankles.

The first decision you need to make is whether you need to have an x-ray to rule out any bone damage. The general rule is if you cannot stand up and put weight through the ankle and are not able to take a few steps then you should seek assessment by a Health Professional. If you’re not sure then it’s always better to be safer than sorry.

You can always seek the advice of a Physiotherapist who can help you decide if an x-ray is needed and often in Emergency Departments the Physiotherapist is the first person to assess ankle sprains and decide if further action is required.

If you have an ankle sprain, and not an ankle fracture, then the treatment you receive initially will depend on how severely you have injured the ankle.

Grade 1 (mild)

• Minor tear
• Minimal pain
• Little or no joint instability
• Mild pain with weight-bearing activities
• Slight loss of balance

Grade 2 (moderate)

• Some tearing of the ligament fibres
• Moderate to severe pain
• Moderate instability of the joint
• Swelling and stiffness
• Pain with weight-bearing activities
• Poor balance

Grade 3 (severe)

• Complete tear of the ligament
• Severe pain followed by minimal pain
• Gross instability of the joint
• Severe swelling
• Possible pain with weight bearing
• Poor balance

Grade 1 sprain may need little or no support for the joint and you will likely begin stretching and exercising to restore normal function as the ligaments heal.

Grade 2 sprain may need some joint support, such as taping or light ankle brace, with some mild exercises to restore range of movement before moving onto more strenuous exercises to restore normal function such as those for a Grade 1 sprain.

Grade 3 sprain is likely to need ankle joint support, such as heavy ankle bracing or even “moon boot”, and may need restricted weight bearing (such as crutches) for a period to allow joint stability to improve before embarking on exercises to restore ankle range of movement and finally ankle strength.

Most ankle sprains heal within 2-6 weeks with some severe ankle sprains taking up to 12 weeks. It is important to fully rehabilitate a sprained ankle as the biggest risk factor for a sprained ankle is previously spraining the ankle. People who recurrently sprain their ankle may be trying to play sport on an unstable joint and hence they keep re-spraining their ankle. This is known as Chronic Ankle Instability. You should seek the advice of a Physiotherapist if this is happening to you. You may need to improve your ankle strength and joint stability before you return to play. One factor that can be overlooked by ankle sprainers, that can contribute to recurring injury, is your proprioception.

Proprioception is the ability for your brain to know where your body parts are in 3D space without looking. Here’s a little test to demonstrate. Close your eyes, keeping your eyes closed, move your left arm into a ‘funny’ position. Now with your eyes still closed, move your right arm to match your left arm position. Now open your eyes – did your arms match? That is proprioception. Your brain is receiving signals telling it how far your shoulder joint has moved and in what direction and so on for the other joints and muscles in your arm.

When you injure your ankle, your brain receives a lot of pain signals from that area of your body and the proprioception signals get a little drowned out. Sometimes after the injury is settling down the brain needs a reminder to listen more to the proprioception signals so it can operate your ankle properly. Your physiotherapist can help you with this. You may receive some balance exercises with differing levels of difficulty to restore your ankle function.

Written by: Adam McKee