Lateral Ankle Sprain

Ankle sprains are one of the most common injuries within a variety of sporting codes and during regular exercise. The lateral (outside) ankle sprain accounts for 85% of all ankle sprains. Often when these injuries occur it can be left untreated and the lack of treatment & rehabilitation leads to the development of the “problem ankle”. This is chronic instability of the ankle which usually is associated with things like muscle weakness, chronic pain, and poor proprioception (a fancy way of saying the body’s awareness of its position). The good news is this can be fixed if you have let it get to the point of becoming a problem ankle. However, the problem ankle will require more time and consistency with rehabilitation to resolve.

Injury usually occurs when the foot is pointing downwards and inwards creating a “rolling” of the ankle during movement or exercise. When the foot is pointing downward (known as plantarflexion), it’s in its most unstable position allowing the “rolling” motion to occur quite easily. The outer ankle consists of 3 ligaments, the ATFL, CFL, and PTFL and any can be involved in the injury depending on foot position and the force involved. The ATFL is the front most ligament out of the three and is the most commonly involved ligament. Ankle sprain injuries are categorised into 3 grades:

         Grade 1: is only minor stretching/tears to the ligaments and will involve some small level of pain, discomfort, swelling and bruising. Full recovery can take up to 6 weeks. 

         Grade 2: involves some significant tearing of the ligaments and usually a moderate amount of swelling and bruising with substantial pain and discomfort, reduced ability to weight bare. Full recovery is usually 8-10 weeks from injury with management.

        Grade 3: is a complete tear of the ligaments and can sometimes be painless. Significant swelling and bruising is usually seen and there can be varied presentations with some people being able to weight bear due to being painless where others may have severe pain. Full recovery can take 12+ weeks with management.

So, what should you do if you roll your ankle and sprain it? Although icing after an acute injury is up for debate I still would Immediately apply ice onto the ankle which will aid early pain management. To ice effectively utilise the 3-sandwich bag method where you put the ice within 3 sandwich bags and make each one airtight. This allows you to put it directly onto your skin and helps the cold penetrate further into the joint than it normally would. Ice for the first 48-72 hours after injury and leave the ice on for 20-30 minutes at a time and at regular intervals. Immobilisation of the ankle may be necessary depending on severity of injury. Your health professional can help make this judgment with you for early management of the injury.  

So how long after injury should you be seeking treatment? That is entirely up to you, but treatment can begin immediately. Depending on the amount of swelling and pain sensitivity in the area, initial treatment may purely consist of swelling and pain management. Once we are able to work a bit deeper and target the damage structures better, our techniques aim to aid the tissues healing capacity. Rehabilitation of the ankle will usually start as soon as physically able to and at various stages of recovery the focus is shifted between improving range of motion, proprioception/balance, ankle stability, and strength.

To all the weekend warriors and sports people alike I hope this can help you to better manage any ankle sprains that may occur in the future.