Ankle Sprains are one of the most common sporting injuries and one of the most common reasons a person will attend ED or see a GP. Whilst a vast majority occur during sports, the ankle can ‘roll’ innocuously whilst walking on uneven surfaces, slipping on stairs or a gutter, or whilst having a boogie on the dancefloor during a night out!
The most common way to injure the ankle is when the ankle rolls inwards (inversion) too forcefully, and the outside ligaments are over-stretched and tear.
What happens if Ankle Sprain is not properly treated?
Unfortunately ankle sprains have a very high recurrence rate. If rehab is done at an inadequate level, the ankle will be susceptible to be weak, have decreased balance and be persistently unstable. This ultimately means that the ankle may roll easily during innocuous activities such as walking.
Clinically we often see patients who have been told to ‘rest’ their ankle and then return to their normal activities. They see us after several re-rolls during simple activities and are frustrated with their pain or loss of stability.
Ankle sprains rarely need surgery, most can be managed well with good physiotherapy programming. The following guide gives physiotherapy insight on how we manage acute and persistent ankle sprains.
The first stage of management is to determine whether the ankle has a fracture. When you roll the ankle you may often hear a crack or a pop. As scary as this sounds, that is most likely the ligament tearing/spraining, ankle fractures are quite rare.
Your physiotherapist may order an x-ray to rule in/out a fracture if you have excessive swelling, inability to put weight through the ankle for a few steps, are extremely tender around the inside and outside bone protrusions (medial and lateral malleoli) or are tender on the 5th metatarsal or navicular bones.
Phase 1: Acute Management of an Ankle Sprain
The initial part of management involves controlling pain, swelling and gently restoring movement. The ankle may be strapped, braced or put in a moon boot if it is too painful and depending on the degree of tear.
Elevation and a long compression sock will often be prescribed to reduce the swelling. The swelling is often what causes the pain, as the joint and tissues have excess fluid that increases pressures.
It is not recommended to take anti-inflammatories within the first 5 days of an ankle injury as that can hinder the tissue healing response. The body needs a natural inflammation period after injury and anti-inflammatories may cause weaker scar tissue formation.
Walking around in a pool (water at heart height or higher) may be beneficial. The orthostatic pressure of the water can help encourage fluid to be pushed out of the ankle joint into the venous system.
Stage 2: Restoration of Range, Strength and Balance Exercises for an Ankle Sprain
As the swelling reduces, the ankle may feel ‘stiff and restricted’. Your physiotherapist may use manual therapy (massage, joint mobilisation) as well as exercises to restore the ankle’s range back to normal.
If the ankle does not get to near its normal range, it may lead to future issues in the knee, foot and hip due to a change in the lower limb biomechanical chain.
The pain from the sprain and swelling will likely have caused weakness and the muscles to switch off. This is called ‘pain inhibition’. A good proportion of a rehab program will target these deficits and restore strength to the calf, ankle evertors and ankle invertors.
Balance and proprioception will naturally be decreased due to the sprain. ‘Proprioception’ is your body’s awareness of what position a joint is in without having to look at it. Eg. close your eyes and touch your nose, form a fist then open your hand in a High-FIve position.
There are cells and sensors in your ligaments, tendons, joint capsule and muscles which determine proprioception. If this is not restored it may lead to reduced balance or reduced reactions.
Stage 3: Sport Specific Exercises for an Ankle Sprain
Once the majority of the Stage 2 deficits have been restored, it is time to train speed and power, and progressively return back to training.
Exercises may involve plyometric activities such as hopping, skipping, bounding, running and jumping to simulate sports. Balance work whilst airborne (eg. being pushed in the air whilst jumping) and landing practice may also be prescribed.
Training up movements such as changing direction, side stepping and backwards running need to be trained so the ankle gets used to these activities. Your physiotherapist will determine what movements need to be trained based on your physical activity goals and ankle pathology.
Finally a graded return to training and sport will be recommended to reduce recurrences and other injuries.
What if I have not done proper ankle rehab before?
It is never too late to begin ankle rehab, results however may take slightly longer to occur. If the ankle is not trained adequately it will continue to have deficits which may lead to persistent instability and sprains.
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible. But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert physiotherapists or massage therapists so we can help you reduce your pain and get you moving again.