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Ankle Sprain

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.

Here you will find everything you need to know about treating and recovering from a sprained ankle as well as rehabilitation and preventative measures to ensure it does not recur again.

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Symptoms & diagnosis

Symptoms 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 could result in hospital treatment and take longer to heal than a broken ankle.

The injury usually occurs from a sudden trauma, twisting or turning over of the ankle. Pain will be felt in the ankle joint itself although 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. Pain can also be felt on the inside of the ankle from compression of bones and soft tissue.

Sprains are graded 1,2 or 3 depending on severity and a professional therapist will carry out a full diagnosis and 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 ankle sprain?

Grade 1 symptoms will 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 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 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.

Anatomy

Ankle ligamentsThe 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 ankle can turn inwards, called an inversion sprain although this is much less common and will usually coincide with a fracture of the fibula bone in the lower leg.

The two main ligaments involved are the talofibular ligament which connects the talus bone in the ankle to the fibula bone and the calcaneofibular ligament which connects the calcaneus or heel bone to the fibula. A less severe ankle sprain will most likely result in damage to the talofibular ligament. However, more severe injuries cause stretching or tearing to the calcaneofibular ligament lower down as well.

Complications

In addition to the ligament damage there may also be damage to tendons, joint capsule, bone, cartilage and other tissues. Severely sprained ankles may result in complete ruptures of the ligaments along with dislocation and fractures of the ankle bones.

  • An avulsion sprain or fracture occurs when the ligament pulls a small piece of bone away with it. This is not always obvious initially but can be suspected if the injury fails to heal.
  • Osteochondral lesions which are tears of the cartilage lining the top of the talus bone are also complications of moderate to severe injuries.

If possible an X-ray should be done, particularly if the patient is unable to put weight on the foot, or it fails to heal properly over time.

Ankle sprain treatment

Cold pack on footImmediate first aid for a sprained ankle is 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 pitch side therapists will bind the ankle tightly in a compression bandage as soon as the injury has occurred to restrict 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. Do not apply ice directly to the skin as it may burn. Treatment with ice may continue for some time during the rehabilitation process.

Rehabilitation program

Ankle strengtheningOur step by step ankle sprain rehabilitation program takes you from injury to full fitness. After the initial acute stage which is usually 24 to 48 hours (but could be longer with a bad sprain) rehabilitation and exercises may begin although only if pain allows. The program is based around three phases of reducing pain and inflammation, restoring normal mobility and building up strength and proprioception (or coordination of the ankle joint).

See ankle sprain rehabilitation program.

Ankle sprain taping

Taping the ankle can provide support and compression post injury and later in the rehabilitation process can give support when returning to full training. Taping can also be helpful if the ankle ligaments have suffered permanent stretching resulting in ankle instability. Professional Football Physiotherapist Neal Reynolds demonstrates how to build up a simple ankle taping technique in four parts. Part 1 is a simple figure of 8 taping and depending on the level of support required builds up to a full basketweave ankle taping.

See ankle taping techniques.

Ankle sprain exercises

Resisted eccentric inversion exercise for ankle sprainsMobility exercises help restore full, pain free range of movement. In the early stages it is important not to stress the ligaments which have been injured so up and down movements of the foot are done as opposed to lateral movements.

Strengthening exercises build up gradually from isometric or static exercises through dynamic exercises involving movement. Some exercises target specific muscles which are important in helping prevent future ankle sprains. It is essential that the proprioception or coordination of the ankle is developed as this is likely to have been damaged at the time of injury making recurrence more likely. Wobble balance board exercises can be beneficial.

Finally functional exercises are more sports specific or activity related to bridge the gap between rehabilitation and full fitness. Functional exercises include hopping, bouncing changing direction and activities more specific to sports training and competitive games.

See ankle sprain exercises.

Expert interviews

We have interviewed professional football physiotherapist Neal Reynolds about how he treats a player with a sprained ankle. We have broken it down into three sections. The first talks about early stage treatment and exercises, the second looks at late stage rehabilitation and the third focuses on future prevention of ankle injuries.

Sports massage

Massage can be beneficial in treating a sprained ankle, particularly in the later stages or with a particularly stubborn injury. We demonstrate some simple cross friction massage techniques to help align scar tissue on the ligaments and interview a teacher of sports massage.

See sports massage for ankle sprains.