“IT’S ONLY AN ANKLE SPRAIN”… COMPLETING REHAB AFTER AN ANKLE INJURY IS A NO-BRAINER
Daniel Reeves (Physiotherapist – Burnie)
- Ankle sprains are not a simple injury
- Ankle sprains require rehab to help prevent ongoing complications and reduce the risk of re-injury
- If your doctor or medical professional does not suggest physiotherapy you can refer yourself to any private physiotherapy clinic, no referral is needed
- It is important to have a physiotherapy assessment after sustaining an ankle injury
- Taping or bracing can help to reduce the risk of recurrent ankle sprains
- If you suffer an ankle sprain call our clinic and book in for an assessment so we can get you back on track and doing what you enjoy
Ankle sprains are one of the most common sports injuries especially in sports such as basketball, netball and football with an incidence rate of 7 per 1,000 exposures. Unfortunately some people (athletes, coaches, parents, health professionals) may think an ankle injury is a minor injury and in many cases appropriate rehab is not performed.
Making sure your ankle injury is managed properly will go a long way to reducing your risk of ongoing complications such as chronic ankle instability and re-injury. This blog will briefly explore ankle sprain injuries, management and rehab.
What Happens When You Sprain Your Ankle?
The most common ankle sprain is called a lateral ankle sprain and occurs when you roll over the outside of your foot/ankle. When you sprain your ankle, ligaments are stretched and can even completely tear. There are 3 ligaments that are commonly involved in a lateral ankle sprain. The anterior-talofibular ligament (ATFL), calcaneo-fibular ligament (CFL) and the posterior talofibular ligament (PTFL).
You can also sustain injury to the anterior tibiofibular ligament that attaches the two lower leg bones together (the tibia and fibula). This is referred to as a high ankle sprain or syndesmosis injury.
A less common injury is the medial ankle sprain which causes injury to the ligaments on the inside of the ankle. These injuries typically take longer to recover.
How Long Does It Take To Heal?
Ligaments take about 4-6 weeks to heal. Depending on the grade of ligament injury sustained it can take anywhere from a few weeks to a few months or longer to return to pre-injury activity.
It is important to have physiotherapy/rehab for your ankle sprain as 20-50% of ankle sprains can lead to chronic ankle instability (pain, swelling & instability). Chronic ankle instability increases the risk of re-injury or sustaining multiple ankle sprains which can lead to an increased risk of osteoarthritis.
It is not uncommon for us at Coastal Physiotherapy to see someone with an ankle sprain 6-12 weeks after their initial injury, despite the importance of seeking physiotherapy following an ankle sprain. This makes it more difficult to determine exactly what you have done and the extent of the injury.
The sooner you can be assessed the sooner you can begin your rehab and be back doing what you enjoy.
If you do not perform rehab for your injured ankle, your risk of future injury and complications is significantly increased.
What Can Increase My Risk Of An Ankle Sprain?
Research has shown a number of factors that increase the risk of an ankle sprain, they include:
- A history of a previous ankle injury
- Wearing shoes with air cells in the heel
- Not performing an adequate warm up involving static stretching and dynamic movement
- Not having normal ankle dorsiflexion range of motion (bending your ankle up)
- Not completing a balance or proprioceptive prevention program if there is a history of previous ankle injury
How Can I reduce My Risk of Injury or Re-injury?
Firstly, make sure you have completed adequate rehab overseen by a Physiotherapist or Exercise Physiologist for any previous ankle injury. There are a number of tests that a Physio or Exercise Physiologist can have you perform to determine your readiness to return to sport and check for any underlying deficits. If you can pass these tests before returning to sport your risk of re-injury will be reduced.
One test is single leg calf raise strength. A good measure of adequate calf strength for the average active person is being able to perform 30 single leg calf raises.
Research has shown that taping or wearing an ankle brace can help to reduce the risk of re-injury and the severity of future injury. Recent evidence supports the use of an ankle brace or taping for at least 6 months following injury. The role of taping or bracing to prevent first time ankle injury is less evident.
How Will Physiotherapy/Exercise Physiology Help?
Your physiotherapist will work with you to restore full ankle movement, improve strength, stability and proprioception of the ankle. This will involve performing exercises at home.
Proprioception is the word used to describe the brain’s awareness of movement; what your joint is doing and where it is in space. I.e. your brain is always receiving messages about the position of your ankle to make sure that you land correctly and do not sprain it. After spraining your ankle you lose some of this proprioceptive awareness and studies have shown that you can reduce the risk of re-injury by improving it. Examples of proprioceptive exercises include balance exercises and jumping/landing.
Other exercises you can expect to perform involve calf strengthening, ankle strengthening, ankle mobility, stretching and hopping variations (see below for exercise examples).
Once your strength has improved and pain has settled, your physio or exercise physiologists will help you to progress to running, jumping, landing, change of direction and eventually return to sport, return to work or your normal daily activities.
Fig. Examples of exercises from top left: Proprioception/balance, ankle inversion & eversion, single leg calf raise.
If someone you know has suffered an ankle injury let them know that we are here to help. Please share with your friends, family and team mates.
Doherty C, et al. The incidence and prevalence of ankle sprain injury, Sports Med (2014) 44:123.
Schiftan G, et al.The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: A systematic review and meta-analysis Journal of Science and Medicine in Sport, Volume 18, Issue 3 , 238 – 244.
Osbourne M, Rizzo T. Prevention and Treatment of Ankle Sprain in Athletes. Sports Med (2003) 33:1145 https://link.springer.com/article/10.2165/00007256-200333150-00005.
McKay GD, Goldie PA, Payne WR, et al Ankle injuries in basketball: injury rate and risk factors British Journal of Sports Medicine 2001; 35:103-108.