A sprained ankle is one of the most common sports injuries. Here we explain the symptoms, causes and treatment for ankle sprains as well as potential complications which are often missed.
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Sprained ankle symptoms
You often know instantly if you have sprained your ankle. Your foot turns inwards under the weight of your body, causing Instant pain.
- Pain may be throughout the joint, or, specifically on the outside of your ankle where the damaged ligaments are located.
- You may feel pain on the inside of your ankle if the bones have been crushed together.
- Your ankle joint may swell up immediately, or may sometimes take up to 48 hours to develop.
- Bruising may also be visible over time.
Ankle sprains are graded 1, 2 or 3 depending on how bad they are.
- More on ankle sprain diagnosis
Similar injuries and complications
It is important to rule out other injuries or complications which may occur with a sprained ankle and are often missed. These include:
The ankle is supported by a number of ligaments which connect bone to bone. The main ligaments involved in a sprained ankle are the tibiofibular and the calcaneofibular ligaments on the outside of the ankle.
Muscles on the inside and outside of the leg
Inversion sprains vs eversion sprains
An inversion sprain is most common. This is where the ankle rolls outwards as the sole of the foot turns inwards. This, therefore, stretches or tears the supporting ligaments on the outside of the ankle.
Eversion sprains are less common and usually occur in
Mild sprains may only damage one of the ligaments whereas a more severe sprain can damage two or more.
- More on Eversion sprains
What causes a sprained ankle?
A number of factors may increase your risk of a sprained ankle:
Proprioception is your body’s awareness and ability to judge the position of body parts and is a leading cause of sprains, especially recurrent injuries.
“People often say they have ‘weak’ ankles but in most cases, they have ankles that are in fact “poor proprioceptively” and not weak at all. Proprioception is the secret to preventing recurring ankle injuries.”Neal Reynolds, Sports Physiotherapist
If you have ever started to turn your ankle over and reacted automatically to stop it, then this is proprioception at work.
Poor proprioception means the muscles would be less able to detect when your joint is at risk of injury, and therefore less able to correct its position of the ankle when needed. This is why proprioception and balance exercises are an important part of rehabilitation.
- More on proprioception
Using the wrong type of shoes for your sport or activity can also increase your risk of a sprained ankle. Make sure shoes fit and are designed for your activity.
- More on choosing shoes
Treatment involves immediate first aid PRICE principles (protection, rest, ice, compression and elevation) following by a full rehabilitation program.
Cold therapy & compression
Apply ice or preferably a cold therapy compression wrap as soon as possible after injury to reduce pain, inflammation, and swelling. If you are using ice make sure it is wrapped in a wet tea towel to avoid ice burns.
Cold therapy can be applied for 10 mins every hour initially, reducing the frequency as your symptoms improve. Elevating the ankle helps reduce swelling by allowing tissue fluids to drain away from the site of injury.
It is important to rest. If you continue to walk or run on an injured ankle you run the risk of it becoming worse. It is much easier to cure a recent injury than it is a long term chronic one.
Wear an ankle brace
Wear an ankle brace or support to protect the injured ligaments and provide compression. Initially, a simple elastic compression sleeve or support is ideal, whilst later in the rehabilitation process, a stronger brace with additional lateral support at the side may help protect the ligaments.
A professional therapist may use electrotherapy, such as ultrasound to help relieve pain and reduce swelling. Ultrasound transmits high frequency sound waves into the tissues for a micro massage effect.
- More on Electrotherapy
Sports massage may be used to help reduce swelling in the acute stage and later cross friction massage directly to the ligament can help prevent scar tissue formation.
Sprained ankle taping
Taping for ankle sprains is used to both protect your injured ankle and improve confidence following injury. Tape supports the damaged tissues in your ankle and activates the surrounding muscles.
- How to tape a sprained ankle
See a sports injury professional
A professional therapist can accurately diagnose your injury and give advice on treatment and rehabilitation. This is essential if you have a severe injury, or one that is not responding to treatment.
- More on when to see a doctor
Our ankle sprain program has been created by England & British Lions Rugby physio Phil Pask and is based on what he would do with his elite players but adapted to suit all levels.
It consists of 4 phases and is criteria based rather than timeline, so you need to reach each phase’s exit criteria before moving onto the next.
This is the acute phase and begins immediately following injury and can last for up to 2 weeks. The aim here is to control pain and stop the bleeding in the joint with rest, cold therapy and compression.
The second phase is an intermediate phase which aims to restore normal function, global stability control, and begin to load your ankle.
Phase 3 is the main rehabilitation phase with more advanced strengthending and movement control exercises.
Phase 4 is the end stage involving more sports specific training.
We explain the treatment and exercises needed to get you back to full fitness including mobility, activation, movement control, strengthening and functional exercises.
- Learn more about our Ankle rehabilitation program
Sideways movements should be avoided early on so as not to put any stress at all on the injured ligaments.
References & further reading
- Cook CE, Hegedus EJ. Orthopedic Physical Examination Tests. 2nd ed. Upper Saddle River, New Jersey: Pearson Education Inc, 2013.
- Fong DT, Hong Y, Chan LK et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med 2007;37(1):73–94.
- Dimmick S, Kennedy D, Daunt N. Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI. J Med Imaging Radiat Oncol 2008;52(6):559–63.
Ankle Sprain Rehabilitation Program
Our step by step rehabilitation program takes you from initial injury to full fitness.
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We recommend the following products for treating ankle sprains:
Cold compresion wrap
A cold therapy and compression wrap is essential first aid. It reduces pain and swelling and can also be used to apply heat later in the rehabilitation program.
Resistance bands are important for most sports rehabilitation and enable you to exercise any muscle from the comfort of your own home.
A foam roller is an excellent piece of kit which can be used in place of massage to treat calf injuries. They are also excellent when use regularly as part of your warm up to help prevent future injury and improve performance.
Ankle supports protect your ankle following injury and give support when returning to full fitness. Some have additional support at the sides to prevent sideways movement of the joint.