An ankle sprain is the most common musculoskeletal injury within the athletic population (Gribble et al., 2016) and accounts for a significant burden on the consumer. So what are they all about, and how do we deal with them?
The Ankle joint:
First, let’s have a look at the ankle joint itself. It’s made up of 3 main bones:
1) The Talus – The lower ankle bone
2) The Tibia – The shin bone
3) The Fibula – Sits next to the tibia in your leg
These three bones, along with their respective muscles and tissues make up the ankle. But there is one more ingredient that has an ever-so important job – ligaments. These structures attach bones together and work to ensure that each of the bones stay in their places and don’t dislocate or shift position. They provide stability to the joint and absorb a great deal of load.
What does this have to do with an ankle sprain?
Well, in a typical sprain – it’s these ligaments that are being injured, or in worse cases, torn. When your ankle moves into a position that is on the outer edges of how it’s meant to move, that’s when ligaments absorb the force attempting to keep the joint stable. Most common type of sprain is that from a rolled ankle – whereby you lose your footing, and your ankle turns inwards, or you step in a hole and your foot gets stuck in that inwards position. In these scenarios, the ligaments on the outside of your ankle take all the force of your body weight trying to keep that ankle stable. In most cases this is too much force for even them to handle, and so they get damaged.
The ligaments you will most commonly injury is that of the ATFL (anterior talo-fibular ligament) which lies on the outside-front of your ankle. This is injured from the action of your ankle rolling inwards, and it’s the most commonly injured as that is the movement that your ankle is inherently most lax towards. Some less commonly sprained ligaments include the deltoid ligament on the inside of your ankle, the CFL ligament on the outside-back of your ankle and the syndesmosis which sits above your ankle in between the tibia and fibula.
Ligament damage is often graded to reflect the extent of damage and give an indication of severity and prognosis.
Grade 1 refers to mild incidences where there is only minimal damage and low amounts of joint laxity if any.
Grade 2 refers to a moderate sprain where damage is more widespread and some of the ligament fibres may be torn resulting in some joint laxity.
Grade 3 refers to a more serious sprain where most if not all ligament fibres are torn leaving you with an unstable ankle.
What does an ankle sprain look and feel like?
Signs and symptoms will usually include bruising and swelling over the injured region (outside of the ankle for an ATFL injury) and most people will have difficulty bearing weight on that ankle without pain.
For initial management, it’s recommended to follow the PEACE protocol and when past the acute stage, it’s recommended to use the LOVE protocol.
(Dubois & Esculier 2019)
How can physiotherapists help?
Physiotherapy plays an integral role in efficient and safe rehabilitation. It’s found that athletes have a higher risk of re-injury following 1 year post initial ankle sprain (Nambiar, 2020). This is due to incomplete or unoptimized rehabilitation which has left the ankle weaker, more unstable or still holding a considerable amount of scar tissue following the injury which has made the ankle more susceptible to further injury.
Your physiotherapist will conduct a thorough and complete assessment of the ankle to construct an individual image of how your ankle has been damaged and what specific structures have been injured to what extent. This then guides management which likely consists of a specific exercise program designed to restore ankle mobility and restrengthen the joint before leading onto return to sport programs if required.
An ankle brace or boot may also be prescribed depending on the condition of the ankle and the extent of the injury. This may be important as in some cases the ankle becomes increasingly unstable following an injury, as the ligaments are too damaged to do their job. A boot or brace works to stabilise the joint and take load off the ligaments, allowing them to heal and reducing the chances of any reinjury.
If you or someone you know has injured their ankle, book an assessment with one of our physiotherapists today for a complete assessment and management plan.
Supporting Reference:
1) Dubois, B., & Esculier, J.-F. (2019). Soft-tissue injuries simply need peace and Love. British Journal of Sports Medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253
2) Gribble, P. A., Bleakley, C. M., Caulfield, B. M., Docherty, C. L., Fourchet, F., Fong, D. T.-P., Hertel, J., Hiller, C. E., Kaminski, T. W., McKeon, P. O., Refshauge, K. M., Verhagen, E. A., Vicenzino, B. T., Wikstrom, E. A., & Delahunt, E. (2016). 2016 consensus statement of the International Ankle Consortium: Prevalence, impact and long-term consequences of lateral ankle sprains. British Journal of Sports Medicine, 50(24), 1493–1495. https://doi.org/10.1136/bjsports-2016-096188
3) Nambiar, S. (2020). Return to play after a lateral ligament ankle sprain. Physio Network, (33).