The most common ankle injury we see are lateral ankle sprains, which account for 85% of all low ankle sprains. They are more commonly known as a “rolled ankle”. A sprain is an injury to a ligament, and more specifically a lateral ankle sprain is an injury to a ligament on the outside of the ankle. These injuries generally occur following a rapid change in direction or landing in an awkward position. There is usually a rapid onset of swelling and pain, and most people often struggle to put weight on the injured ankle. Some people may also hear a “pop” or a “snap” at the time of injury. The most commonly injured ligament is the anterior talofibular ligament (ATFL), followed by the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL).
Based on your history and a clinical examination your physiotherapist will be able to diagnose and grade your lateral ankle sprain.
- Grade 1: partial tears to the ATFL
- Grade 2: complete tear of the ATFL + partial tears to the CFL
- Grade 3: complete rupture of the ATFL, CFL and PTFL
- Grade 3 injuries may also be associated with a dislocation of the ankle and possible fractures
The reason lateral ankle sprains (outside ligaments) are much more common than medial ankle sprains (inside ligaments) is due to the following:
- The ligaments on the inside of the ankle are much stronger and broader in comparison to those on the outside.
- There is greater movement into inversion (sole of the foot facing inwards), especially when the ankle is positioned in plantar flexion (pointed toe). For example, standing on your toes or wearing high heels, which puts greater stress on the outside ligaments.
- The muscular support on the outside of the ankle lacks the speed to contract and protect the lateral (outside) ligaments at the time of injury.
Initial treatment of these injuries begin with swelling and pain management. This includes following the SPRICEMM protocol.
- Support and Protect: with the use of taping or bracing
- Rest: this does not mean ceasing all activity, rather it means to limit vigorous physical activity
- Ice: apply ice for 20 minute intervals every 2-3 hours
- Compression: using a tubi grip or compressive taping
- Elevation: raising and resting your ankle above the level of your heart
- Movement: gradual and early movement helps to shift swelling, promote healing and avoid stiffening of the ankle joint. A lot of people want to use crutches when they injure their ankle, however controlled movement and gentle weight bearing is often better.
- Medication: if required seek advice from your pharmacist or GP in regard to pain medication
Once pain and swelling begin to resolve, treatment then shifts towards exercise and restoring normal joint movement. A large focus of the exercise program includes strengthening of the lateral ankle muscles, stretching of the plantarflexor muscles and improving or restoring ankle proprioception (knowing where your joint is in space). Below are a few exercises you can try at home!
- Everter strengthening with theraband
- Heel raises, making sure that your ankle doesn’t roll out!
- Single leg standing
- Standing on a bosu ball or wobble board
- Progression: add a ball, catch a throw to yourself whilst maintaining your balance!
- Calf stretch
Depending on the severity and grade of your ankle sprain, it can take roughly 4-6 weeks to recover and return to sport. Your physiotherapist will be able to give you a more accurate timeframe.
If you have an ankle sprain it is recommended that you see your physiotherapist as soon as possible (day 1 if able). Your physiotherapist will perform a thorough assessment and provide you with a more personalised exercise program. They will perform manual techniques to assist in restoring normal ankle joint movement and provide you with more tailored advice. If you suspect that you have a lateral ankle sprain, please see your physiotherapist to kick start your rehab! Click here to see our availabilities.