Ankle Sprain

Ankle sprains are some of the most common sports injuries, often recurring again and again. In most cases the ankle is rolled outwards, resulting in damage to the ligaments on the outside of the ankle.

It is important to get the correct treatment for an ankle sprain as soon as possible after injury and then follow a full ankle sprain rehab program to get back to full fitness and ensure the injury does not recur.

Sprained ankle symptoms

Sprained ankleSymptoms of an ankle sprain may vary from being very mild to very severe. With a mild sprain the athlete will likely be able to continue with training or competition. A very sever injury will result in hospital treatment and take longer to heal than a broken ankle.

An ankle sprain will usually occur from a sudden trauma, twisting or turning over of the ankle. Pain will be felt in the ankle joint itself although pain will specifically be felt on the outside of the ankle when pressing in on the damaged ligaments. Swelling or bruising may be present but not always in the more mild cases.

Ankle sprains are graded 1,2 or 3 depending on severity and a professional therapist will carry out a full diagnosis and ankle sprain assessment which will include range of motion tests and resisted movement tests to determine the structures injured and extent of the damage.

How bad is my sprained ankle?

Anterior drawer test for ankle sprainAnkle sprain recovery time will depend on how bad the injury is. Sprained ankles, as with all ligaments sprains, are diagnosed as grades 1, 2 or 3 depending on their severity:

Grade 1 ankle sprain symptoms with cause only mild pain with little or no instability. There may be some joint stiffness with difficulty walking or running but the athlete is likely to be able to play on. Some stretching or perhaps minor tearing of the lateral ankle ligaments may have happened resulting in mild swelling around the bone on the outside of the ankle.

Grade 2 sprained ankle symptoms will result in moderate to severe pain with difficulty walking. The athlete is unlikely to be able to play on and will limp. Minor bruising may be evident along with swelling and stiffness in the ankle joint. There is likely to be some instability of the joint resulting from moderate tearing of some of the ligament fibres.

Grade 3 sprain ankle sprain usually results in a total or almost complete rupture of a ligament. Severe pain will be felt initially with lots of swelling and extensive bruising. The athlete will experience gross instability of the joint.

Ankle sprains explained

Ankle sprainThe most common is an inversion sprain or lateral ligament sprain where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments and other soft tissues on the outside of the ankle.

The most common damage sustained in a sprained ankle is to the anterior talofibular ligament. This ligament, as the name suggests, connects the talus with the fibula bone. If the sprain is severe there might also be damage to the calcaneofibular ligament which connects the calcaneus or heel bone to the fibula further back towards the heel. This ligament only becomes injured in more severe injuries.

In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, which is why it is important to get a professional to diagnose your ankle sprain. If possible an X-ray should be done, as small fractures or avulsion fractures where a tendon or ligament pulls a small piece of bone away are not uncommon. Osteochondral lesions or tears of the cartilage lining the top of the talus are also frequent complications of moderate to severe ankle sprains.

Severely sprained ankles, where there are complete ruptures of the anterior talofibular, calcaneofibular and posterior talofibular ligaments, result in dislocation of the ankle joint which are often associated with a fracture.

Sprained ankle treatment

Ice on ankle sprainTreatment of a sprained ankle can be separated into immediate first aid and longer term ankle rehabilitation and strengthening. When considering how to treat a sprained ankle the aims should be to reduce pain and swelling then restore full mobility and strength.

Immediate first aid for a sprained ankle

Aim to reduce the swelling by RICE (Rest, Ice, Compression, Elevation) as soon as possible. Cold therapy or ice should be applied for 10 to 15 minutes every hour for the first 24 to 48 hours. Often professional therapists will bind the ankle tightly in a compression bandage as soon as the injury has occurred to prevent swelling, although this must be done with caution for only 10 minutes at a time to prevent starving the area of blood resulting in further injury.

Following the initial acute stage of a sprained ankle exercises should begin as soon as pain allows to maintain ankle mobility and build strength and co-ordination or proprioception in the ankle. See ankle sprain rehabilitation program for more details. A wobble board is an important part of rehabilitation of ankle sprains.

How can a professional practitioner help?

Ankle tapingA sports injury specialist will undertake a thorough assessment of the injury so time is not wasted treating the wrong condition and hopefully any complications can be identified early on. A doctor may prescribe anti-inflammatory medication (e.g. ibuprofen) to help with pain and swelling.

Swelling can be reduced by using compression devices or applying ankle wraps and ankle taping techniques. Specialist cryotherapy devices which apply cold and compression automatically are used widely by professional sports teams.

Ankle exercisesUse of electrotherapy such as ultrasound and laser treatment can reduce pain and inflammation and promote healing. Cross friction massage after the initial acute stage can reduce scar tissue development.This may be important if the injury has become chronic or fails to healing properly over time.

A professional physical therapist will prescribe ankle sprain exercises as part of a full ankle rehabilitation program to strengthen the joint and help prevent future ankle sprains.