What is an Ankle Sprain?
The ankle joint is the connection between the bones of the lower leg (the tibia and fibula) and the uppermost bone of the foot (the talus). Like all the body’s joints, the bones are held together with rigid connective tissues called ligaments. These ligaments are responsible for holding the bones in alignment. When the alignment of the bones moves beyond the capacity of the ligaments to restrain them, injury to the ligaments can occur. This sort of injury occurs most commonly when you roll your ankle to the side, like in the image below.
When this rolling of the ankle occurs, the injury is termed a sprain. A sprain is an injury to the ligaments where they are stretched beyond their tolerance. Ankle sprains can cause a lot of pain and swelling.
Because rolling onto the outside of the foot is the most common mechanism of injury, it is usually the ligaments on the outside of the ankle that is stretched and hence injured.
Injuries to the ligaments are graded depending on their severity:
- Grade 1: Mild sprain
- Grade 2: Moderate sprain with microtears to the ligament
- Grade 3: Severe sprain with complete rupture of the ligament
A physiotherapist can perform tests to identify the severity of the injury and to rule out ankle fractures. If the bones around your ankle are very tender to touch, you have a lot of trouble walking a few steps or you have diagnosed osteoporosis, it is important that you check with a healthcare professional to make sure there is no fracture.
How do you treat an Ankle Sprain?
Mild ankle sprains may return to normal function within days to a couple of weeks, whilst severe sprains can take up to a few months. The general goals of ankle sprain rehabilitation are to manage the symptoms (especially in the early phase of the injury) and to maximise function of the ankle as the ligaments heal.
During the first few days following the injury, your ankle will likely be quite sore and swollen. Whilst pain can be managed, remember that it is your body’s way of protecting the injured area. Similar advice applies to the swelling and inflammation – previously it was thought that minimising swelling could improve recovery, but it is actually the body’s first stage of healing, so whilst reducing swelling might help your symptoms in the short term, it may impact the healing process. For this reason, it is probably a good idea to avoid ibuprofen if not necessary.
Although you may need a period of relative rest following an ankle sprain, the main, evidence based approach is to get moving as early as you can. Early exercise interventions can reduce the risk of recurrent injury, ankle instability and make the recovery time quicker! For mild ankle sprains, a return to your normal exercise routine with a combination of cardiovascular and resistance training is appropriate, but if you are coming back from a grade 2 or 3 sprain, you may need specific ankle exercises to restore baseline strength, movement and proprioception (awareness of the body’s position). It is debated whether supervised exercise is superior to unsupervised exercise following an ankle sprain, but if in doubt, check with a local physiotherapist.
How do you prevent Ankle Sprains occurring?
Previous ankle sprains are a significant risk factor for future sprains, and when ankle sprains become a regular occurrence during walking, sports or other meaningful activities, it can be incredibly frustrating, preventing you from engaging in exercise and physical activity. For this reason then, it is worthwhile considering how to prevent future ankle sprains.
1) Exercise rehabilitation
As has been discussed in the section on treatment, early exercise is important to regain strength, movement and proprioception of the ankle. Not only does exercise make for a faster recovery time, it also reduces the risk of recurrent ankle injuries.
2) Taping and bracing
Some people will also benefit from taping and bracing to allow them to participate in their exercise of choice, be it hiking, tennis or walking around the block! Taping the ankle can provide more security but can cause skin irritation if left on for long periods and requires knowledge of the taping technique. Ankle braces are a better choice for those who need extra support regularly or those with sensitive skin. The choice between taping and bracing is dependent on your preference, as both have been shown to be effective in ankle sprain prevention.