Ankle sprains are very common, particularly in sports such as rugby, netball and football. In fact, they account for a quarter of all sports injuries. At this time of year, rugby and football pitches may be frozen and netball courts slippery which may predispose some of us to ankle injuries.
What is a sprained ankle?
A sprained ankle is a soft-tissue injury to the ligaments and sometimes the capsule surrounding the ankle joint. The injury can lead to bleeding and inflammation of the tissues which can cause a painful, swollen and sometimes bruised ankle. As your ankle joint and ligaments provide your brain with a lot of feedback about where your ankle is in space, following an ankle sprain it is common to feel a bit unbalanced or as if your ankle may give way.
What are the types of ankle sprain?
The most common type of ankle sprain involves the ligaments on the outside of the ankle in which the ankle has turned inwards or inverted.
You can also sprain your ankle by rolling your ankle in the other direction (eversion) injuring the ligaments on the inside of the ankle – however this is less common.
Ankle sprains are graded dependent on how much soft-tissue is thought to be damaged:
Grade I – a mild stretching of the ligament without instability, there may be mild swelling with little functional loss.
Grade II – a partial rupture with mild instability which usually involves an isolated ligament, there may be moderate swelling and bruising with moderate functional loss.
Grade III – a complete rupture of the ligaments resulting in instability of the joint, there is likely to be severe swelling and bruising with difficulty weight-bearing through the affected ankle.
What should I do if I sprain my ankle?
For the first 48 hours following an ankle sprain it is important that you rest, ice and elevate the ankle. If swelling is present, you may wish apply ice to the ankle in 20 minute bursts; this not only helps to reduce the swelling but can also help to relieve some of the pain. Ensure you do not apply ice directly to the skin (always place a towel between the ice and bare skin).
There is evidence to suggest that early mobilisation and functional treatment produces better outcomes than immobilising the ankle. Therefore, after the initial 48 hours it is important to get your ankle moving again as pain allows whilst you gradually increase how much weight you bear through it.
For more severe grade III sprains, you may be advised to wear an ankle brace for the initial phase of healing to help stabilise the ankle and help it heal. There is nothing wrong with wearing an ankle brace or support for comfort in the early stages of recovery, however it is important that you do not become dependent on it and begin using the ankle again as early as possible.
When should I seek physiotherapy input for my sprained ankle?
Most ankle sprains are self-managed and don’t require treatment at a physiotherapy clinic. However, if your ankle has swelled and bruised it is likely that you have sustained a grade II or III injury which will most likely will require some input from a Chartered Physiotherapist. If you have followed the advice above but are still experiencing moderate levels of pain or having difficulty bearing-weight on your ankle after a 3-4 days; it is advisable to seek treatment. If your swelling and pain has eased but you are experiencing loss of or excessive ankle movement, or feeling as if the ankle is unstable or giving way, it may also be indicated to see advice from a healthcare professional.
What does physiotherapy for a sprained ankle involve?
Physiotherapy during the recovery phase focuses on regaining ankle range of movement, strength and proprioception. It may involve any of the below:
- Advice, reassurance.
- Hands-on ankle mobilisation or ankle range of movement exercises to help restore normal joint range.
- Ankle strengthening exercises – this may involve isometrics or through-range strengthening with a Theraband progressing to more dynamic, weight-bearing and functional exercises.
- Coordination/proprioceptive exercises – to improve the pathways between the brain and ankle, to help restore stability and balance, this may involve standing on one leg and challenging your balance through the use of balance pads and wobble-boards.
- Taping/strapping – to help stabilise the ankle in the initial recovery phase or on return to sport.
- Ultrasound – to assist with reducing any swelling.
- Sports-specific rehabilitation.
Will I need surgery?
There is evidence to suggest that even with grade III/unstable ankle sprains that there is no improved outcome from having surgery over a good rehabilitation programme. The only times in which surgery may be indicated is in such cases where there is disruption of the syndesmosis above the ankle leading to widening of the ankle mortice and chronic instability/recurrent sprains. There may also be a role for surgery in the highly athletic population who have higher demands on their body and are therefore at higher risk of re-injury.
What is the prognosis of an ankle sprain?
Most people who suffer from an ankle sprain make a complete recovery. Dependent on the grade of sprain your recovery may vary from 2 weeks to 36 months (with the majority of recovery occurring in the first 6 months).
How long before I can return to sport safely?
In grade I sprains and in the absence of pain it is usually safe to return to sport approximately 2 weeks following an ankle sprain. In more severe sprains it is dependent upon your level of pain and function and which sport you wish to return to. In such cases it is advisable take guidance from your Physiotherapist who can tailor an individual rehabilitation programme with sport-specific goals.
What can I do to help prevent myself from spraining my ankle?
Approximately 80% of people who suffer an ankle sprain are at risk of re-injury. You may be more susceptible if you have not regained your pre-injury level of mobility, strength, proprioception and coordination prior to returning to sport. In such cases it may be advisable to apply an ankle brace or strap your ankle before playing high-risk sports.
If you do not have a history of ankle sprain but play a high-risk sport such as netball or basketball, it is wise to ensure you wear the correct footwear so that your ankle is stabilised adequately. Some people may choose to wear ankle braces prophylactically.
For more information about ankle braces or if you wish to purchase one see the link below.
There is evidence to suggest that if you have a muscle imbalance somewhere in the body or increased body mass that you are at higher risk of ankle sprain whilst playing sports. It is therefore important that you maintain a good level of overall muscle strength, flexibility and endurance by training regularly and retaining your health and fitness.
If you have any questions or wish to seek some physiotherapy input following an ankle sprain, do not hesitate to get in touch with us. We have some of the best physiotherapists in London who specialise in the assessment and treatment of sports-injuries. Call us on 020 7404 6343 or email [email protected].