Ankle Sprain - Don't Make It a Chronic Problem!

Updated: May 4


An ankle sprain refers to the tearing of the ligaments of the ankle and accounts for approximately 40% of all athletic injuries. In addition 40% of those who experience an ankle sprain have recurrent symptoms. (3)


85% of ankle sprains occur on the outside (lateral side) of the ankle and are known as an inversion sprain. This is the type of injury that most runners experience when they sprain their ankles. Medial ankle sprains (along the inside of the ankle) occur less frequently and are usually caused by fractures or other traumatic events. (1)


Without appropriate treatment and rehabilitation, a severely injured ankle may not fully heal and could lose its stability. This loss of stability could, in turn, result in chronic ankle pain, recurrent sprains, gait imbalances, osteoarthritis, and a path of on going dysfunction.

So, why is an inversion sprain so common? You can put it down to our lopsided anatomy! The bone on the lower outside of the ankle (the lateral malleolus - distal fibula) extends further down than the bone on the inside of the ankle (medial malleolus – fibula). This difference gives the inside of the ankle (medial side) more stability than the outside of the ankle (lateral side).

At a symptomatic level, most ankle sprains appear to resolve completely without rehabilitation. In reality, ankle sprains that have not been rehabilitated correctly are usually susceptible to further injury.


Recent Research: Research now shows that individuals with a history of recurrent ankle sprains demonstrate decrease muscle firing activity of the ankle, knee, and hip when performing tasks. This is called AMI (Athrogenic Muscle Inhibition). This shows that an ankle sprain not only affects the local area but can cascade up the entire leg. (2)

ANATOMY OF AN ANKLE SPRAIN

The outside (lateral side) of the ankle achieves its stability from a three-ligament complex. These three ligaments are the:

In an inversion sprain, the Anterior Talofibular ligament (ATFL) is the most commonly injured ligament.(4) Ligaments in the ankle are named according to the bones to which they connect. In this case, the Anterior Talofibular ligament connects to the talus bone of the ankle as well as to a long bone of the lower leg - the fibula. The function of the ATFL is to prevent forward (anterior) displacement of the ankle (the talus).

In a severe ankle sprain another ligament called the calcaneofibular ligament (CFL) may also be damaged. This ligament connects your heel bone (calcaneous) with the fibula. This is a stronger ligament than the ATFL, and is not damaged as easily.

Both the ATFL and the CFL are usually damaged in motions where the foot is both pointed down (plantar flexed) and rolled out (inverted). Considerable instability in the ankle can occur when both these ligaments are injured.

The posterior talofibular ligament (PTFL) is not injured very often, except when there is a complete dislocation of the ankle (talus). The PTFL is the strongest ligament in the lateral complex.

Another sprain injury that is becoming more prevalent is called a “High Ankle Sprain” (syndesmotic ligament complex). In this injury, the ligament and connective tissue between your shin bones (tibia and fibula) are torn. This is a serious injury that may require surgery to resolve.

Not Just Ligaments

An ankle sprain may also result in damage to other structures. You may also experience damage to connective tissue, tendons, muscles further up the ankle, and even to the bones (possible fractures). This is why, with a severe ankle sprain, it is important to see a medical professional who can determine exactly which structures have been injured, and then provide treatment recommendations.



Anatomy of the Lateral Ankle & Foot: Want to learn more about the anatomy that is involved in an ankle click the video to the right.









TREATMENT OF AN ANKLE SPRAIN

THE ACUTE STAGE

Immediately after spraining your ankle, it is important to do everything you can to reduce the swelling in the ankle. The faster you can implement treatment, the faster you will recover. An ankle sprain injury that is addressed quickly will often resolve in a short period of time. If the injury is ignored, the ankle sprain could be prolonged for extensive periods of time.

So, immediately after the injury, while still in the acute stage - use RICE - rest, ice, compress, and elevate!

  • Rest: During this stage, it may be necessary to take all weight off of the injured ankle. In such cases, crutches are commonly used. In my opinion, it is important to quickly return to weight-bearing as soon as possible to improve healing. I have found that reintroduction of weight-bearing stresses tends to decrease recovery time. When should you do this? As soon as possible, but not too soon! Rest is also essential.

  • ICE: Ice for at least 20 to 30, minutes 4 to 5 times per day to reduce swelling. In most cases we do not recommend icing long than 72 hours after the initial injury.

  • Compression: Compression (with an ACE wrap) reduces both swelling and bleeding. With a Grade 3 sprain, wear a brace at all times until you are able to bear weight on your ankle.

  • Elevation: Elevating the injured area acts to reduce swelling and bleeding.

Once you have used “RICE”, it is very important to introduce motion into the ankle as soon as possible. Depending on the degree of injury, the patient could be asked to perform gentle ankle circles, or if able to do so, write the alphabet with their feet. Light calf stretching and using a stationary bicycle may also be beneficial.


Ankle Exercises - Acute Injury: Here are examples of ankle mobilization exercises after an ankle injury. These exercises are often combined with RICE: Rest, Ice, Compression and Elevation. These exercises are only for the acute stage of injury to increase fluid exchange and get rid of waste by products.




MANUAL THERAPY FOR AN ANKLE SPRAIN

Manual therapy can make a huge difference in the recovery and prevention of an ankle sprain. Manual therapy speeds healing by increasing blood supply, oxygen, essential nutrients, and displace waste products that accumulate after an injury. This is especially important in treating ligaments because they generally have a very poor blood supply to begin with.


The following videos are a few examples of how we would address both soft tissue and joint dysfunction using Motion Specific Release (MSR) procedures.



4 Point Dorsi Flexion Protocol: Dorsiflexion is the movement at the ankle joint where the toes are brought closer to the shin. The muscles of the shins help your foot to clear the ground during the Swing Phase (concentric contraction) of your stride, and absorb much of the impact shock during running.




MSR - 7 Point Ankle & Foot Mobilization: Improving joint mobility is critical if you are going to effectively address the body's full kinetic chain. In fact, we greatly reduce the effectiveness of any myofascial treatmen