top of page

Ankle Sprains: Sidestepping the Path to Chronic Pain with Kinetic Health

Updated: Mar 10


Race image with a focus on ankles and feet

An ankle sprain involves tearing the ankle ligaments and is responsible for about 40% of all athletic injuries. Interestingly, 40% of those who suffer an ankle sprain also experience recurring symptoms.


Article Index:

 

Introduction


Inversion sprains, which affect the outside (lateral side) of the ankle, make up 85% of all ankle sprains. Most runners experience these types of injuries. In contrast, medial ankle sprains (located on the inside of the ankle) are less common and typically result from fractures or other traumatic incidents.


When an ankle is severely injured, inadequate treatment and rehabilitation can prevent it from healing completely, leading to reduced stability. This instability may cause chronic ankle pain, recurrent sprains, imbalanced gait, osteoarthritis, and an ongoing pattern of dysfunction.


Bruised ankle after ankle sprain

The reason inversion sprains are so widespread can be traced back to our uneven anatomy. The bone on the lower outside of the ankle (lateral malleolus - distal fibula) extends further down than the bone on the inside (medial malleolus – fibula), providing the inside of the ankle (medial side) with greater stability than the outside (lateral side).


Although most ankle sprains seem to resolve completely without rehabilitation, they're actually more prone to further injury if not treated properly.


Recent research indicates that individuals with a history of recurrent ankle sprains exhibit decreased muscle-firing activity in the ankle, knee, and hip when performing tasks, a phenomenon known as Athrogenic Muscle Inhibition (AMI). This suggests that an ankle sprain's impact isn't limited to the local area but can extend throughout the entire leg.


 
ligamentous Anatomy Image

ligamentous Anatomy


The outside part of the ankle, or the lateral side, gains its stability from a combination of three ligaments: the Anterior Talofibular Ligament (ATFL), the Calcaneofibular Ligament (CFL), and the Posterior Talofibular Ligament (PTFL).


When an inversion sprain occurs, which is when the ankle turns inward, the most frequently injured ligament is the ATFL. Ligaments are typically named based on the bones they connect. In this instance, the ATFL links the talus bone in the ankle to the fibula, a long bone in the lower leg. The primary role of the ATFL is to prevent the forward displacement of the ankle or the talus.


Another ligament, the CFL, might also sustain damage in cases of a severe ankle sprain. This ligament bridges your heel bone (the calcaneus) and the fibula. Compared to the ATFL, the CFL is more robust and less likely to suffer injury.


Movements where the foot is pointed downwards (plantar flexed) and rolled out (inverted) can potentially harm the ATFL and CFL. If these two ligaments are damaged, significant instability in the ankle can arise.


The PTFL, the strongest ligament in the lateral complex, is seldom injured except in instances of a complete ankle dislocation (talus).


There's also a sprain known as a "High Ankle Sprain" (syndesmotic ligament complex) that's becoming increasingly common. In this type of injury, the ligament and connective tissue between your shin bones (the tibia and fibula) get torn. This injury is serious and may necessitate surgical intervention.


 

Runner standing on the track

The Kinetic Chain


Ankle sprains can result in damage to various structures, such as connective tissues, tendons, muscles, and nerves. A comprehensive understanding of these injuries, commonly seen in lateral ankle sprains and high ankle sprains, is essential for effective treatment and prevention of future sprains.


Tendons: In inversion sprains, the Peroneal Tendon is often injured, and during recovery, it may be displaced from its normal position, a condition known as subluxation. It's crucial to address this issue during the recovery stage of an ankle sprain to promote proper healing.


Muscles: Peroneus Brevis and Peroneus Longus are two muscles frequently involved in ankle sprains. Longitudinal tears of the Peroneus Brevis are commonly associated with lateral ankle sprains, while the Peroneus Longus may exhibit altered activation patterns due to muscle restrictions that form after ankle instability. If not addressed, these restrictions could predispose individuals to recurrent injuries. Both muscles function to evert the foot at the tarsal joint and plantar-flex the foot at the ankle.


Retinaculum: The retinaculum is a band of connective tissue that secures the peroneal tendons in place. A tear in the retinaculum can cause a snapping sensation in the lateral ankle. Severe retinaculum tears might not be suitable for standard manual therapy and may require surgical intervention.


Understanding the complexities of these injuries allows for the development of a comprehensive, effective treatment plan for ankle sprains. This facilitates faster recovery and reduces the risk of future sprains.


 

Silhouette image of ankles

Ankle and Foot Examinations


Ankle and foot examinations play a vital role in diagnosing and managing injuries like ankle sprains. A comprehensive assessment includes orthopedic, neurological, and vascular tests, each focusing on different aspects of the injury.


Orthopedic tests evaluate bones, muscles, and ligaments, identifying specific areas of concern. Neurological tests ensure nerve function is intact, while vascular examinations check blood circulation, crucial for healing.


We've included demonstration videos to help you better understand these examination procedures, emphasizing their importance in effectively addressing ankle sprains and related conditions.


Effective Ankle and Foot Examination This video uses an orthopaedic test to evaluate some of the most common ankle and foot conditions we see in clinical practice. These conditions include: Ankle Sprains (inversion sprain), Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fracture, Syndesmosis damage, Achilles Tendon Tendinopathy, Morton's Neuroma, 2nd Metatarsal Stress Fracture, Plantar Fasciitis, and Bunions.


Lower Limb Neuro Examination

The lower limb neurological examination is part of the overall neurological examination process and assesses the motor and sensory neurons that supply the lower limbs. This assessment helps detect any impairment of the nervous system and is used both as a screening and an investigative tool.


Peripheral Vascular Examination - Key Points

A peripheral vascular examination is valuable for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video, we review some common procedures we perform in daily clinical practice.


 

Managing An Ankle Sprain


The Initial Phase


Your priority right after an ankle sprain should be to minimize swelling in the area. Swift initiation of treatment often leads to a quicker recovery. Addressing the injury promptly can result in a relatively short healing period, while neglecting it may prolong your discomfort.


Therefore, in the immediate aftermath of the sprain - during the initial phase - remember to follow the RICE protocol: Rest, Ice, Compression, and Elevation!

Ankle Wrapped in Bandage

Rest: In the initial stage, it might be necessary to completely offload the injured ankle, often using crutches. However, I believe it's essential to reintroduce weight-bearing as soon as feasible to expedite healing. The careful reintroduction of weight-bearing stress can potentially shorten recovery time. The right time to do this? As soon as you can, but without rushing! Remember, rest is equally important.


Ice: Applying ice for 20 to 30 minutes, 4 to 5 times daily can help reduce swelling. Generally, we advise against icing beyond 72 hours post-injury.


Compression: Compression, typically achieved with an ACE wrap, helps mitigate swelling and bleeding. If you have a Grade 3 sprain, a brace should be worn continuously until you can bear weight on your ankle.


Elevation: Raising the injured area can further reduce swelling and bleeding.

After implementing the "RICE" protocol, it's crucial to reintroduce motion to the ankle as soon as possible. Depending on the severity of the injury, the patient might be advised to perform gentle ankle circles or, if capable, to 'write' the alphabet with their feet. Gentle calf stretching and using a stationary bicycle could also be beneficial.


Ankle Exercises - Acute Injury

Here are examples of ankle mobilization exercises after an ankle injury. These exercises often combine 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 Ankle Sprains


Manual therapy, including Motion Specific Release (MSR), is crucial for healing and preventing ankle sprains. It accelerates healing by improving blood flow, oxygenation, and nutrient delivery to the injury, crucial for ligaments with poor blood supply. MSR, a diverse treatment system, addresses soft tissue and joint issues through various techniques, offering personalized, holistic care.


Upcoming videos demonstrate MSR's application in ankle sprain recovery, showcasing the significant benefits of manual therapy and MSR's role in enhancing recovery and preventing future sprains.


Rehab Ankle Sprains - Treatment

Treatment runs from the time stamp 01:00 - 6:15. 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 ongoing dysfunction. In this video, Dr. Brian Abelson and Miki Burton RMT show you effective ways of addressing this common condition.


MSR - 7  Point Ankle & Foot Mobilization Video
Click Image to Watch the Video

MSR - 7 Point Ankle & Foot Mobilization

Improving joint mobility is critical for effectively addressing the body's full kinetic chain. In fact, addressing joint mobility restrictions greatly reduces the effectiveness of any myofascial treatment.



 

Nerves and Ankle Sprains


Nerves can also be affected during an ankle sprain, particularly in the case of lateral ankle sprains (inversion sprains). Addressing nerve-related issues is vital for successful treatment and recovery.


Superficial Peroneal Nerve: This nerve is at risk for traction injury during a lateral ankle sprain. Specific MSR (Motion Specific Release) procedures are designed to release the peroneal nerve if it is involved in the injury. Proper treatment of this nerve injury can aid in a more effective recovery process.


Peroneal Nerve Release Video
Click Image to Watch the Video

Peroneal Nerve Release: Peroneal nerve injuries are the most common peripheral nerve injury in the lower extremity. Most of these injuries occur in the fibular head region (common peroneal nerve). MSR procedures may be employed to address such injuries, focusing on releasing the peroneal nerve to improve function and promote healing. Click on the Video to see MSR procedures demonstrating peroneal nerve release techniques.


 

Woman Performing a Deadlift

Exercises for Ankle Sprains


Once a lateral ankle sprain's acute stage has subsided, initiating a rehabilitation program is critical. This program should involve three key components: enhancing flexibility and mobility, strengthening the affected muscles, and honing balance and proprioception. Each of these aspects plays a crucial role in a successful recovery and the prevention of future injuries.


Flexibility and Mobility: Regaining range of motion and flexibility in the ankle is paramount to restoring normal function. This may involve specific stretching exercises tailored to your individual needs and the severity of your injury.


Strengthening: Building strength in the muscles surrounding the ankle aids in providing support and stability to the joint. These exercises can be customized to your unique circumstances and will be crucial in preventing recurring sprains.


Balance and Proprioception Training: This element of rehabilitation is essential to retrain the body's sense of position and movement (proprioception), which can be disrupted after an ankle sprain. Balance exercises help restore this awareness, reducing the risk of future injuries.


While the following exercises are potential components of a rehabilitation program, it's important to note that the exact regimen will be specifically tailored to each individual and the severity of their injury.


Rehab Ankle Sprains - Exercise and Treatment

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 ongoing dysfunction. In this video, Dr. Brian Abelson and Miki Burton RMT show you effective ways of addressing this common condition. (Exercises start at Time Code 08:45)


Balance Exercises for Beginners Video
Click Image to Watch the Video

Improve Your Balance - Exercises for Beginners

Balancing exercises are essential components of Rehabilitation and Sports Performance training. They should not be overlooked, as they can enhance one's ability to stabilize the body during functional movements. Incorporating simple balance exercises into a progressive training program can improve balance and prevent injuries.


Improve Your Balance - Advanced Exercise

Balance exercises can benefit people of any age. They improve one's ability to control and stabilize one's body's position, reducing injury risk, rehabilitating current injuries, and increasing sports performance. This exercise routine should only be performed after doing the beginner series for several weeks.


 

Women Sprinters

Rehabbing Ankle Sprains Conclusion


Recovering from an ankle sprain involves understanding the injury, managing its acute stage, and following a structured rehabilitation plan. A holistic approach is essential, incorporating the RICE protocol immediately after the injury, seeking professional therapies like Motion Specific Release (MSR) when needed, and following a rehab program that enhances flexibility, strength, and balance.


Recognize that your body's parts are interconnected. While focusing on the ankle, also pay attention to the surrounding areas, as their health impacts overall recovery.


Recovery might seem lengthy, but with patience and the correct methods, you can regain your ankle's health and prevent future injuries, returning to your active life. Always consult healthcare professionals for tailored treatment, considering the severity of the sprain, your health, and your lifestyle. The ultimate aim is not just healing but building a stronger, more resilient body for future challenges.


 

DR. BRIAN ABELSON DC. - The Author


Photo of Dr. Brian Abelson

Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred personalized care.


As the motion-specific release (MSR) treatment systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.


 

References:

  1. Wolfe MW. Management of ankle sprains. Am Fam Physician 2001; 63(1): 93-104.

  2. Effects of Tibiofibular and Ankle Joint Manipulation on Hip Strength and Muscle Activation, Lawrence MA, Raymond JT, Look AE et al. Journal of Manipulative and Physiological Therapeutics 2020; 43(5): 406-417.

  3. Fukuhara T, Sakamoto M, Nakazawa R, et al. Anterior positional fault of the fibula after sub-acute anterior talofibular ligament injury. J Phys Ther Sci 2012; 24(1): 115-117.

  4. Fong DT, Chan YY, Mok KM, Yung PS, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. BMC Sports Science, Medicine and Rehabilitation. 2009 Dec 1;1(1):14

  5. 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.

  6. Waterman, B. R., Owens, B. D., Davey, S., Zacchilli, M. A., & Belmont Jr, P. J. (2010). The epidemiology of ankle sprains in the United States. JBJS, 92(13), 2279-2284.

  7. Hertel, J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of Athletic Training, 37(4), 364.

  8. Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J., & Bleakley, C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports medicine, 44(1), 123-140.

  9. 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.

  10. 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. The American journal of medicine, 121(4), 324-331.

  11. Hubbard-Turner, T., & Turner, M. J. (2020). Physical activity levels in college students with chronic ankle instability. Journal of Athletic Training, 55(2), 181–186.

  12. Martin, R. L., Davenport, T. E., Paulseth, S., Wukich, D. K., & Godges, J. J. (2013). Ankle stability and movement coordination impairments: ankle ligament sprains. Journal of Orthopaedic & Sports Physical Therapy, 43(9), A1–A40.

  13. Han, K., Ricard, M. D., & Fellingham, G. W. (2021). Effects of a 4-Week Exercise Program on Balance Using Elastic Tubing as a Perturbation Force for Individuals With a History of Ankle Sprains. Journal of Sport Rehabilitation, 30(1), 14-20.

  14. Thompson, C., Schabrun, S., Romero, R., Bialocerkowski, A., & Marshall, P. (2020). Factors contributing to chronic ankle instability: a systematic review and meta-analysis of systematic reviews. Sports Medicine, 50(1), 67-80.

  15. Gribble, P. A., Bleakley, C. M., Caulfield, B. M., Docherty, C. L., Fourchet, F., Fong, D. T., ... & McKeon, P. O. (2016). Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. British journal of sports medicine, 50(24), 1496-1505.

  16. Hébert-Losier, K., Wessman, C., Alricsson, M., & Svantesson, U. (2018). Updated reliability and normative values for the standing heel-rise test in healthy adults. Physical therapy, 98(8), 674-681.

  17. Kim, K. M., Hart, J. M., Saliba, S. A., Hertel, J., & Ingersoll, C. D. (2011). Effects of balance training on ankle joint stiffness in adults with chronic ankle instability. International journal of sports medicine, 32(07), 577-583.

  18. Sulowska, I., Mika, A., Oleksy, Ł., & Stolarczyk, A. (2019). The influence of plantar short foot muscle exercises on the lower extremity muscle strength and power in proximal segments of the kinematic chain in long-distance runners. BioMed Research International, 2019.


 

Disclaimer:

The content on the MSR website, including articles and embedded videos, serves educational and informational purposes only. It is not a substitute for professional medical advice; only certified MSR practitioners should practice these techniques. By accessing this content, you assume full responsibility for your use of the information, acknowledging that the authors and contributors are not liable for any damages or claims that may arise.


This website does not establish a physician-patient relationship. If you have a medical concern, consult an appropriately licensed healthcare provider. Users under the age of 18 are not permitted to use the site. The MSR website may also feature links to third-party sites; however, we bear no responsibility for the content or practices of these external websites.


By using the MSR website, you agree to indemnify and hold the authors and contributors harmless from any claims, including legal fees, arising from your use of the site or violating these terms. This disclaimer constitutes part of the understanding between you and the website's authors regarding the use of the MSR website. For more information, read the full disclaimer and policies on this website.




bottom of page