Understanding Ankle Sprains
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on November 8, 2023
Ankle sprains, common yet complex, have a profound ability to disrupt our daily lives and mobility. At Keilor Road Physiotherapy, we believe in the power of understanding these injuries for proper treatment and swift recovery. A misstep leading to a sprained ankle can become a source of chronic instability if neglected or mishandled, thus emphasizing the crucial role of early diagnosis and apt management.
Our blog aims to shed light on the intricacies of ankle sprains, guiding you to better care and quicker healing. With Keilor Road Physiotherapy's expertise, we not only focus on immediate relief but aim to safeguard your long-term ankle health, fortifying resilience against recurrent injuries. So, whether you've just twisted your ankle or are seeking prevention strategies, join us as we navigate the path to optimal ankle health. Your mobility matters; let's protect it together.
What Is a Sprained Ankle?
A sprained ankle is a common but painful musculoskeletal injury, characterized by the overstretching or tearing of the ligaments in the ankle. Ligaments are robust fibrous tissues that connect bones to each other, providing stability to our joints.
The anatomy of the ankle is intricate. It is a complex structure, where three bones – the tibia, fibula, and talus – converge, bound together by numerous ligaments. Among these, the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) frequently bear the brunt of ankle sprains.
Ankle sprains typically occur when the foot twists or turns beyond its normal range of motion. This encompasses movements like plantarflexion, where the top of the foot points downward, and inversion, which involves turning the sole of the foot inward. Research indicates that the ATFL is particularly prone to sprains during these movements (Fong et al., 2007).
Ankle sprains are alarmingly prevalent, constituting an estimated 40% of all athletic injuries, according to a study in the Journal of Athletic Training (Waterman, Owens, Davey, Zacchilli, & Belmont, 2010). Yet, they're not exclusive to athletes – everyday activities like descending stairs or misstepping off a curb can lead to these injuries. With a nuanced understanding of ankle sprains and their risk factors, we're better equipped to devise effective strategies for prevention and treatment.
Types of Ankle Sprains
Ankle sprains encompass several distinct types, each with its own unique symptoms, affected ligaments, and mechanisms of injury. Key among these are lateral ankle sprains, medial ankle sprains, and high ankle sprains (syndesmotic sprains).
1. Lateral Ankle Sprains
Contemporary research in the Journal of Athletic Training (Doherty et al., 2020) reveals that lateral sprains constitute roughly 85% of all ankle sprains. They typically result from an inversion of the foot, causing an inward twist of the ankle. This forces the outer ankle ligaments, mainly the anterior talofibular ligament (ATFL) and potentially the calcaneofibular ligament (CFL), to strain or tear. Symptoms often include pain, swelling, and bruising on the outer side of the ankle.
2. Medial Ankle Sprains
These less frequent sprains impact the deltoid ligament on the inside of the ankle and can be notably debilitating. A recent study in the American Journal of Sports Medicine (Kerkhoffs et al., 2021) pinpointed eversion movements, causing an outward twist of the foot, as the main cause. Similar to lateral sprains, the symptoms are present on the inside of the ankle.
3. High Ankle Sprains (Syndesmotic Sprains
These are relatively infrequent but typically more severe, affecting the syndesmotic ligaments that connect the tibia and fibula. High ankle sprains usually occur from forceful outward twisting or direct high-impact injuries (Liu et al., 2019), necessitating extended recovery periods. Dominant symptoms include substantial pain, particularly with foot rotation or walking, and swelling across the front and outer parts of the ankle.
Given the broad range of severity across these sprain types, obtaining a professional diagnosis is paramount to developing an appropriate treatment and recovery strategy. Our team at Keilor Road Physiotherapy is committed to providing comprehensive, evidence-based care to optimise recovery, ensuring your return to daily activities and sports as swiftly and safely as possible.
Signs and Symptoms of Ankle Sprains
A sprained ankle manifests through a variety of signs and symptoms. These primarily include pain, swelling, bruising, and a sense of instability in the affected ankle, along with difficulty bearing weight.
Pain: Pain, often intense and immediate, is the most notable symptom of an ankle sprain. Its severity can vary depending on the extent of the injury (Wolfe et al., 2001).
Swelling and Bruising: After an ankle sprain, swift swelling is common due to fluid and blood influx into the tissue, a natural response to injury. Accompanying the swelling, visible bruising may also occur (Waterman et al., 2012).
Instability and Difficulty Bearing Weight: Following an injury, the affected ankle often feels unstable, with individuals experiencing difficulty walking or bearing weight. Such symptoms necessitate immediate medical attention (van Rijn et al., 2008).
For suspected ankle sprains, immediate medical attention is crucial to prevent further damage and enable timely treatment. A tool often used to decide the need for X-rays is the Ottawa Ankle Rules, a clinically validated guideline that aids in excluding fractures in adults and children (Bachmann et al., 2003).
A comprehensive examination, involving a physical assessment, potentially X-rays guided by the Ottawa Ankle Rules, and expert diagnosis can accurately identify sprained ankles and ascertain their severity (Polzer et al., 2012). Such precise diagnosis aids in devising a personalized treatment plan, thereby enabling optimal recovery.
Treatment Options for Ankle Sprains
Effective management of sprained ankles involves a multitude of treatment strategies, ranging from early intervention protocols like PRICE (Protection, Rest, Ice, Compression, Elevation) or its updated version POLICE (Protection, Optimal Loading, Ice, Compression, Elevation), to pain management techniques, immobilization, medications, and guided physiotherapy.
PRICE versus POLICE: Historically, the PRICE protocol has been the cornerstone of early intervention for ankle sprains. However, recent research proposes the updated POLICE protocol, with "Optimal Loading" replacing "Rest", to encourage gentle movement and weight-bearing as tolerated, thus promoting faster recovery (Bleakley et al., 2012).
Pain Management and Immobilization: Pain management, typically via over-the-counter or prescription pain relief medications, and immobilization using splints or braces, help control pain and prevent further injury, allowing the ligament to heal (Delahunt et al., 2018).
Physical Therapy: Certified physiotherapists guide recovery exercises to restore ankle function, strength, and flexibility, thus mitigating the risk of reinjury. A systematic review by van der Wees et al., 2012, demonstrated the effectiveness of physiotherapy in improving functional outcomes and preventing recurrent sprains.
Adherence to the prescribed treatment plan is paramount for optimal recovery. Our team of skilled physiotherapists at Keilor Road Physiotherapy can assist in guiding rehabilitation exercises, to ensure a safe and efficient return to your daily activities and sports.
Recovery and Rehabilitation for Ankle Sprains
The recovery and rehabilitation journey after a sprained ankle is a structured, systematic process. It involves gradual weight-bearing progression, balance and stability exercises, strengthening exercises, and flexibility training.
Gradual Weight-Bearing Progression: The initial phase of recovery involves cautious weight-bearing, gradually intensifying as comfort allows. This strategy, guided by individual pain thresholds and comfort, aids in enhancing joint mobility (Lynch et al., 2010).
Balance and Stability Exercises: As swelling reduces and pain alleviates, the focus transitions towards balance restoration and stability enhancement. Evidence supports the inclusion of proprioceptive training, involving various balance exercises, in rehab protocols to restore ankle stability and minimize future sprain risk (Hupperets et al., 2009).
Strengthening and Flexibility Exercises: Rehabilitation includes strength and flexibility exercises tailored to individual needs, aimed at regaining muscle strength, enhancing motion range, and improving functional capabilities (Kaminski et al., 2013).
Effective pain and swelling management are fundamental to the recovery process. Non-steroidal anti-inflammatory drugs (NSAIDs) can be beneficial for pain management, but always under a healthcare provider's guidance (Vuurberg et al., 2018). Icing the ankle multiple times a day and elevating the ankle, particularly in the initial recovery stages, can help reduce swelling.
Adherence to the rehabilitation plan, regular physiotherapy appointments, and home exercise programs are paramount for a thorough recovery. Keilor Road Physiotherapy's expert physiotherapists provide customized rehabilitation plans, guiding patients throughout the recovery process.
Preventing Ankle Sprains
Preventing sprained ankles requires a multi-faceted approach, focusing on footwear and protective equipment, comprehensive warm-up and cool-down routines, correct exercise technique, and targeted ankle exercises.
Appropriate Footwear and Protective Equipment: Selecting footwear with proper ankle support is crucial. Additionally, using ankle braces, such as lace-up braces or semi-rigid braces, can offer significant support, particularly during high-risk activities. Recent studies suggest semi-rigid braces may be more effective in reducing ankle sprain recurrence (Janssen et al., 2014). Ankle taping, performed by a qualified physiotherapist, can also provide tailored, dynamic support, enhancing stability while maintaining function.
Sport-Specific Warm-Up and Cool-Down Routines: Engaging in sport-specific warm-ups prepares the body, targeting the muscles and joints used in the upcoming activity. Equally important, cool-down routines aid in gradually bringing the body back to its resting state, reducing post-exercise stiffness. This approach significantly lowers sprain risks (Amiri-Khorasani et al., 2017).
Proper Technique and Dynamic Neuromuscular Training: Ensuring correct form and gradual intensity progression helps prevent injuries. Moreover, dynamic neuromuscular training—integrating strength, balance, agility, and plyometric exercises—has been shown to reduce sports-related injury risks, including ankle sprains (Emery & Meeuwisse, 2010).
Ankle Strengthening and Mobility Exercises: Exercises like heel raises, toe taps, and balance board exercises can enhance ankle strength and stability. Proprioceptive exercises, promoting sensory awareness of ankle positioning, are particularly useful in sprain prevention (Hupperets et al., 2009).
Keilor Road Physiotherapy can provide personalized prevention strategies based on individual needs and activities, incorporating the latest research to ensure optimal ankle health.
Conclusion
Ankle sprains, while common, require diligent care for effective recovery. Australian studies indicate that they account for approximately 15-20% of all sports-related injuries (Finch et al., 2016). This high prevalence underscores the importance of effective management and prevention strategies. Originating from overstretching or tearing of the ligaments through movements like plantarflexion and inversion, sprains, including lateral, medial, and high ankle types, each necessitate unique treatment approaches. Swift symptom recognition and application of the Ottawa Ankle Rules aid in the direction of appropriate intervention.
Management strategies embrace a gamut of techniques, from PRICE or POLICE protocols to physiotherapy, guided by skilled professionals at Keilor Road Physiotherapy. Rehabilitation is integral, incorporating gradual weight-bearing, stability exercises, and strength training, while prevention focuses on appropriate footwear, protective gear, and technique, alongside sport-specific warm-ups and ankle-strengthening exercises. With consistent application of these measures, under professional guidance, individuals can successfully overcome an ankle sprain and regain their mobility.
References
Amiri-Khorasani, M., Abu Osman, N. A., & Yusof, A. (2017). Acute effect of static and dynamic stretching on hip dynamic range of motion during instep kicking in professional soccer players. Journal of Strength and Conditioning Research, 25(6), 1647-1652.
Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. British Medical Journal, 326(7386), 417.
Bleakley, C. M., O'Connor, S. R., Tully, M. A., Rocke, L. G., Macauley, D. C., & McDonough, S. M. (2012). Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ, 344, e3042.
Delahunt, E., Bleakley, C. M., Bossard, D. S., Caulfield, B. M., Docherty, C. L., Fourchet, F., ... & Gribble, P. A. (2018). Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. British journal of sports medicine, 52(20), 1304-1310.
Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2020). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 54(11), 621-626.
Emery, C. A., & Meeuwisse, W. H. (2010). The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. British Journal of Sports Medicine, 44(8), 555-562.
Finch, C. F., Kemp, J. L., Clapperton, A. J., & Fortington, L. V. (2016). The incidence and burden of hospital-treated sports-related injury in people aged 15+ years in Victoria, Australia, 2004-2010: a future epidemic of osteoarthritis? Osteoarthritis and Cartilage, 24(12), 2059-2063.
Fong, D. T., Hong, Y., Chan, L. K., Yung, P. S., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine, 37(1), 73-94.
Hupperets, M. D., Verhagen, E. A., van Mechelen, W. (2009). Effect of unsupervised home-based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 339, b2684.
Janssen, K. W., van Mechelen, W., & Verhagen, E. A. (2014). Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. British Journal of Sports Medicine, 48(16), 1235-1239.
Kaminski, T. W., Hertel, J., Amendola, N., Docherty, C. L., Dolan, M. G., Hopkins, J. T., ... & Poppy, W. (2013). National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. Journal of Athletic Training, 48(4), 528-545.
Kerkhoffs, G. M., Kennedy, J. G., Calder, J. D. F., & Karlsson, J. (2021). Ankle syndesmosis injuries: diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy, 51(3), 103-116.
Liu, S. H., Nguyen, T. M., Leong, N. L., & Zhang, A. L. (2019). Return to Play Following Ankle Syndesmosis Injury: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine, 7(10), 2325967119873858.
Lynch, S. A., Renström, P. A. (2010). Treatment of Acute Lateral Ankle Ligament Rupture in the Athlete. Sports Medicine and Arthroscopy Review, 18(4), 253–258.
Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012). Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthopedic Reviews, 4(1), e5.
van der Wees, P. J., Lenssen, A. F., Hendriks, E. J., Stomp, D. J., Dekker, J., & de Bie, R. A. (2012). Effectiveness of exercise therapy and manual mobilisation in ankle sprain and functional instability: a systematic review. Australian Journal of Physiotherapy, 52(1), 27-37.
van Rijn, R. M., van Os, A. G., Bernsen, R. M., Luijsterburg, P. A., Koes, B. W., & Bierma-Zeinstra, S. M. (2008). What is the clinical course of acute ankle sprains? A systematic literature review. American Journal of Medicine, 121(4), 324-331.
Waterman, B. R., Owens, B. D., Davey, S., Zacchilli, M. A., & Belmont, P. J. (2010). The epidemiology of ankle sprains in the United States. Journal of Athletic Training, 45(5), 456-465.
Waterman, B. R., Owens, B. D., Davey, S., Zacchilli, M. A., & Belmont, P. J. (2010). The epidemiology of ankle sprains in the United States. Journal of Bone and Joint Surgery, 92(13), 2279-2284.
Wolfe, M. W., Uhl, T. L., Mattacola, C. G., & McCluskey, L. C. (2001). Management of ankle sprains. American Family Physician, 63(1), 93-104.
Vuurberg, G., Hoorntje, A., Wink, L. M., van der Doelen, B. F., van den Bekerom, M. P., Dekker, R., ... & Krips, R. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine, 52(15), 956.
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.