Sprained Ankle
Contents
Stretches
Strengthening Exercises
Have you sprained your ankle or suffering from ankle joint pain? Read our article on ankle ligament injuries and how you can manage them:
Ligaments of the Ankle
The ankle joint is held together by ligaments and a joint capsule. There are quite a few ligaments involved (see the list below) and they are important for providing stability to the ankle joint. Unfortunately, when these ligaments are injured, we lose stability and the risk of reinjury is quite high.
An ankle sprain is one of the most common sport injuries and any of the ligaments listed below can become sprained when the ankle is twisted suddenly. When this happens, you may experience pain, swelling, weakness, and bruising.
Ligaments on the outside of the ankle
anterior talofibular ligament
calcaneofibular ligament
posterior talofibular ligament
Ligaments on the inside of the ankle
deltoid ligaments
High ankle sprains
anterior and posterior inferior tibiofibular ligament
interosseous membrane
Which Ankle Ligament is Most Commonly Injured?
The most common ligament that is usually involved in an ankle sprain is the talofibular ligament, which is located on the outside of the ankle. However, it is important to note that an ankle sprain usually involves more than one ligament.
These ligaments typically become sprained with inversion injuries, which is when the ankle rolls inward. The positioning of these ligaments is what makes them more susceptible in ankle inversion injuries.
Apart from the talofibular ligament, the following are also commonly involved in ankle sprains:
Calceneofibular Ligament
Posterior Talofibular Ligament
Anterior Talofibular Ligament
Grading/Classification of Ankle Sprains
When a person suffers an ankle sprain, the injury needs to be classified in order to provide an overview of how severe the damage is and how long it will take to recover. By grading the severity of the ankle sprain, it will also provide the patient and specialist with more accurate details for the best approach to treatment.
Grade 1 Ankle Sprain
Grade one is a relatively mild case of an ankle sprain. The ankle will not be torn when the patient is diagnosed with a grade one ankle sprain. In most cases, this classification means there will be minimal downtime, and recovery time will not take as long.
Grade 2 Ankle Sprain
A partially torn ligament in the ankle will usually be classified as a grade two sprain. In this case, pain, inflammation, and disability may be experienced for a longer period of time. Bruising may occur when a patient suffers a grade two ankle sprain.
Grade 3 Ankle Sprain
A grade three ankle sprain usually means the patient has suffered a full-thickness ligament tear ankle injury. In this case, there will be a much more significant recovery time, and symptoms will generally be worse.
Recovery Time
When it comes to understanding how long a person will need for the condition to heal, it is important to consider the recovery time for each grade of an ankle sprain. The more severe the condition, the longer it will take for the patient to fully recover from the injury.
Below is an overview of the expected recovery time needed for people with an ankle sprain, dependent on the grade of injury:
Grade 1 sprain: About two to four weeks. At four weeks, there should be no more inflammation, and the patient should have restored complete mobility of the ankle.
Grade 2 sprain: About six to eight weeks for mobility to restore, and swelling to go down completely.
Grade 3 sprain: Depends on the severity of the tear. This may take anywhere from 12 weeks up to six months to fully heal and recover as surgical intervention may be considered in severe cases.
Symptoms
So what does an ankle sprain feel like? Understanding the symptoms is important as this provides clues as to the severity of your injury and can help distinguish between a minor sprain, a more serious ligament tear, or at worst, a fracture.
General symptoms that will develop with ankle ligament damage tend to include:
Swelling, bruising, and discolouration around the ankle and foot
Stiffness in the ankle
Tenderness to touch
Pain with weight bearing
A ruptured ankle ligament may cause much more severe swelling and pain symptoms. The range of motion will be greatly affected, and the person will be unable to place any type of weight on the ankle or foot.
IMPORTANT! If you cannot put weight on your ankle the day after an ankle sprain, it is important to have this assessed by a sports chiropractor. However, in most cases, ankle sprains from sport are typically NOT medical emergencies that require a visit to the hospital unless there is severe trauma or impact.
First Aid for a Sprained Ankle
The initial steps you take immediately after an ankle injury can dramatically improve your recovery time. Therefore it is important to understand what to do immediately after an injury so that you can limit inflammation and promote recovery.
To heal a sprained ankle fast, you need to control the inflammation, especially in the first 24-36 hours. Traditional methods include the RICE protocol which involves:
Rest
Ice
Compression
Elevation
If the injury has occurred on the sporting field, maintaining compression around the ankle is vital so that swelling can’t build around the ankle. One of the best ways to do this is to keep the athlete’s shoe on. You can then place ice around their shoe and put their foot up on a chair to provide elevation.
When you get home, place a compression sleeve around the ankle and keep it on at all times (even when you sleep). Continue wearing the compression sleeve until there is no swelling around the ankle, which may take 1-2 weeks. In most cases, it is normal for swelling to then push into the foot and this is usually not a concern.
While sprained ankle treatment at home is possible, you also need to be mindful of when the injury is beyond an ‘at-home fix’. If you experience severe pain, extensive bruising and discolouration, and pain with trying to put any weight on the ankle, it is important to have this assessed by a sports chiropractor to avoid further complications.
Does Walking on a Sprained Ankle Make it Worse?
This really depends on the severity of the sprain. In grade 1 or 2 sprains, this is usually not an issue. In fact, short spurts of walking will actually help pull swelling out of the ankle and foot. However, in grade 3 tears, walking and extra pressure on the ankle may actually make the injury worse. For more details on how to grade an ankle sprain, see the section above: Grading/Classification of Ankles Sprains
If you are unable to put weight on your ankle, it is best to rest until this has cleared. In the meantime, it is still advisable to gently move your foot up and down to assist in pulling the swelling out of the ankle.
Treatment
Ankle sprains are typically managed in clinic without surgery or referral to a specialist. Unfortunately with ankle injuries, they have a high risk of re-injury, which means that once you’ve suffered an ankle sprain at some point in your life, you are highly likely to re-injure that ankle again!
The specific treatment plan for your ankle sprain will depend on the grade of the sprain and how many ankle sprains you’ve had in the past. Treatment for a sprained ankle or torn ankle ligament will typically include a combination of hands-on manual therapy, taping, joint mobilisation, and rehabilitation exercises.
When treating ankle sprains, the first phase is to restore full range of movement using a variety of mobilisation techniques. This is a critical part of the treatment program as the ankle range of motion will often be impaired after a sprain. The treatment will focus on the soft tissues located around the ankle joint, which will also help alleviate inflammation and release tight muscles.
Taping and bracing may also be used in the initial stages of the recovery process. As we mentioned earlier, ankle sprains have a high risk of re-injury and thus protecting it with tape or a brace can decrease that risk.
Learning how to fix a sprained ankle with taping can be done at home when the injury is not too severe. However, it is best to be shown how to properly strap an ankle by a certified sports chiropractor as certain taping techniques have been shown to irritate the Achilles tendon.
Ankle supports/braces may also be recommended in some instances of ligament damage. In these cases, the patient will need to wear the brace for a prescribed period of time to assist with the recovery.
In regards to rehabilitation exercises, patients will be shown a combination of balance and strengthening exercises. Single leg balances exercises are important to improve the patient’s proprioception (balance), which will help prevent reinjury. Strengthening exercises of surrounding ankle muscles will also be required in most cases and this will be specifically catered to that person’s activity or sport.
Up to 40% of patients with an ankle sprain may experience ankle instability after the injury has healed. By completing an individualised rehabilitation program, this problem can often be avoided, as the soft tissues in the region will be strengthened and stabilised.
Exercises
Ankle sprains are one of the most common sports injuries and also have a particularly high risk of reinjury. Sprained ankle rehab is important if patients want to avoid this. While rest is recommended in the initial stages of the injury, it is important to begin rehabilitation as soon as the swelling has decreased.
Various exercises may be recommended to a person who needs to undergo ankle sprain rehab. It is important for the patient to recognize which exercises are appropriate - and to avoid those activities that might cause a risk of further damage to the ankle ligaments.
Stretches
After an ankle injury, it is important to stretch the Achilles tendon, but only if it does not exacerbate the ankle pain. This can be done by performing calf and towel stretches. Watch our video below for some simple calf stretches:
Strengthening Exercises
There are also several strengthening exercises that the patient can take advantage of. By improving the overall strength of these muscles and ligaments, healing will not only happen faster, but there will also be a reduced risk for future injury.
Sprained ankle exercises can help improve the strength of the ligaments and muscles in the region. In turn, this can ensure that the injured parts will heal faster and more effectively.
Give these strengthening exercises a try:
Single leg balance: stand on one leg with the knee slightly bent. When you feel balanced, close your eyes and time how long you can stay balanced. Make sure you are doing this in an open and safe area.
Draw the alphabet: stand on one leg and draw each letter of the alphabet by moving your body weight around on the ankle that’s on the ground.
Heel lifts: stand on both feet and come up on to your toes, trying to work on the calves. If that becomes easy, progress to doing one leg at a time.
Strapping a Sprained Ankle
Learning how to strap a sprained ankle is important, as the compression and support provided by the tape can greatly speed up recovery and also ease some of the pain. A variety of different materials can be used, such as a crepe bandage, a tensor bandage, or rigid tape.
Rigid strapping tape is one of the most preferred options. The width of the tape depends on the size of the patient's ankle, and the severity of the sprain. In most cases, a tape width of 38mm is adequate.
When trying to learn how to strap an ankle with ligament damage, it is important to take extra care not to cause further injury to the ankle.
To learn how to tape an ankle, please see the video below:
How to Tell if an Ankle is Sprained or Broken?
Understanding the difference between a sprained and a broken ankle is important, as the treatment provided for the two conditions is different. A broken ankle (fracture) is much more serious and will require immediate medical attention. To put it bluntly, it is virtually impossible to diagnose a broken ankle at home.
To properly diagnose whether an ankle has been fractured, a sports chiropractor needs to do a series of physical examinations and potentially refer for x-rays if required.
When the ankle bone breaks during injury, a cracking sound will sometimes be present but not always. With a sprain, there may be no noise, or sometimes just a “popping” noise. If tenderness can be felt directly over the bony area where the ankle was injured, then there is also a likeliness for a fracture. Lastly, if the patient finds it particularly difficult to put weight on their ankle, this is an important sign that they should see a certified sports chiropractor to have it properly assessed.