An ankle sprain is very common. It is actually one of the most common musculoskeletal injuries (second most common in sport). It is an injury that occurs when you roll, twist or turn your ankle in an awkward way. Oftentimes it happens when you play sport, step off the pavement or walk down the stairs. And yes, it usually happens when you least expect it! 🙂
Four main causes of an ankle sprain are:
- Trips, slips, and falls that cause your ankle dislocation
- Landing awkwardly on your foot – happened to me when playing basketball in college
- Walking or exercising on an uneven surface
- Another person stepping or landing on your foo(i.e. in football)
Symptoms of a sprained ankle
Signs and symptoms vary and depend on the severity of the injury. They may include:
- Pain, especially when you bear weight on the affected foot
- Tenderness when you touch the ankle
- Restricted range of motion
- Instability in the ankle
- Popping sensation or sound at the time of injury
Sprained ankle and ligaments damage
In a sudden and quick movement your foot is taken out of its normal position. This, in turn, puts a lot of pressure on the ankle joint and supporting, adjacent tissues including ligaments, tendons, muscles, nerves, and blood vessels. Ligaments are particularly prone to damage in this injury.
For a long time we thought about ligaments as structures stabilizing the joints and not allowing excessive movements. Yes, that’s true, they are fantastic fulfilling this role. However, this is not the only function they have to play.
There are many nerve receptors in ligaments that send information to the brain about the position of your foot, movement, and intensity (proprioception). After an ankle sprain, this function may be impaired and the ankle joint may feel unstable. This is what happens in more severe ankle injuries (grade 2,3). You may experience a clicking sensation or the feeling that the ankle is giving way, especially with spontaneous movements.
Pain is also a result of triggered pain receptors in your ankle (nerve endings) that register what happened and communicate that to the brain.
Types of ankle sprains
An inversion injury ( lateral ankle sprain) is the most common type of ankle sprain (85% of all ankle sprains). The foot rolls inward, with a risk of causing the damage to three ligaments — the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament.
Much less common are sprains affecting the ligaments of the inner ankle (so-called medial ankle sprains). Also rare are syndesmotic (high ankle) sprains (0.5% of all ankle sprains without fracture), which injure the tibiofibular ligaments — the ligaments that join the two leg bones (the tibia and the fibula) just above the ankle.
Syndesmotic sprains occur most often in contact sports such as American football and downhill skiing. They may lead to chronic ankle instability and subsequent sprains in the future.
Ankle sprains and severity scale
The severity of an ankle sprain depends on two factors:
1. The amount of damage
2. How unstable the joint becomes as a result.
The more severe the sprain, the longer the recovery and rehabilitation process
The worst injuries require months of rehabilitation (see table below)
Grades of ankle sprain severity
|Severity||Damage to ligaments||Symptoms||Recovery time|
|Grade 1||Minimal stretching, no tearing||Mild pain, swelling, and tenderness. Usually no bruising. No joint instability. No difficulty bearing weight.||1–3 weeks|
|Grade 2||Partial tear||Moderate pain, swelling, and tenderness. Possible bruising. Mild to moderate joint instability. Some loss of range of motion and function. Pain with weight-bearing and walking.||3–6 weeks|
|Grade 3||Full tear or rupture||Severe pain, swelling, tenderness, and bruising. Considerable instability and loss of function and range of motion. Unable to bear weight or walk.||Several months|
|Source: Adapted from Maughan KL, “Ankle Sprain,” UpToDate, version 14.3, and Ivins D, “Acute Ankle Sprain: An Update,” American Family Physician (Nov. 15, 2006), Vol. 74, No. 10, pp. 1714–20.|
Recovery after an ankle sprain
Grade 1 injuries – try treatment at home first
So you have just sprained your ankle and wonder what to do? I would say, if there is no immediate swelling (may be visible the following day), you have not heard any sinister pops, cracks, or snapping noises while sustaining the injury, and the pain level is not too bad – you can try some treatment at home. Some experts still recommend the RICE protocol which means 4 things:
REST, ICE (first 48 hrs critical, apparently), COMPRESSION, ELEVATION
This approach had been in use for a long time. More and more, however, we think that doing NOTHING and letting your ankle heal on its own is the best option. That’s it – leave your ankle alone and let the body do the magic instead.
After 10-14 days, most ankle sprains (grade 1) will feel better.
I would avoid strenuous exercise such as running for up to 6- 8 weeks, as there’s a risk of further damage.
Grade 2, 3 injuries – have it checked!
If you sustained your injury at high speed, are in a lot of pain and your ankle looks like a balloon – the best thing you can do is call a doctor and have it examined. It may be that you will be advised to follow the steps above for a few days first. Or, you may need some radiological scanning to evaluate the damage and the best option for your treatment and rehabilitation.
Severe sprains can take months to get back to normal so be patient and understand this is really important and can’t be rushed.
With more severe grade 2 and grade 3 sprains your walking is likely to be affected. Even more so if you need to wear an orthosis or a boot on your ankle. With restricted foot and knee movements, your leg muscles will not work properly. You may also notice a loss in calf and thigh musculature. The unused muscles will slowly get weaker and weaker. Eventually, you can even start to have problems with other joints as compensatory mechanisms kick in. These include knee, hip, and spine problems
Severe grade 2 and 3 cases can cause chronic pain, stiffness, and proprioceptive issues if left untreated, as often the effect of immobilization are almost as bad as the injury.
Without proper treatment and physiotherapy, a severely injured ankle may not heal well. It could lose its range of motion and stability, resulting in recurrent sprains.
The recovery for Syndesmotic Ankle Sprain is often twice that of a typical ankle sprain!
There are three:
These occur when you fail to treat a sprained ankle properly or decide to get back to sport too soon. Also, those who sprained their ankle once or twice before, are at higher risk of developing complications.
How to prevent an ankle sprain
Here are some tips to help you prevent an injury to the ankle
- Always warm-up before you exercise or play sports.
- Be careful and prepare ahead for walking, running or working on an uneven surface.
- Use an ankle support brace or tape on a weak or previously injured ankle.
- Wear shoes that fit well and are made for your activity.
- Minimize wearing high-heeled shoes.
- Don’t play sports or participate in activities for which your body is not ready
- Maintain good muscle strength and flexibility.
- Practice stability training, including balance exercises.
Exercises to do at home
And now the best part! A few exercises that will help you with recovery and return to normal activities. Your foot and calf muscles will be doing a lot of work in these. In the beginning, work on the ankle joint’s correct range of motion before moving on to strength-shaping exercises.
There are so many other exercises you can find online! And plenty useful videos on YouTube too!
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I am a Chartered Physiotherapist and Master Myofascial Therapist practicing in Southampton, Hampshire. I was working in the NHS between 2008 and 2021. My speciality lies in treating musculoskeletal conditions and providing community rehabilitation.