Ankle sprain? How to get back on your feet!

Ankle sprains are incredibly common, ranking as the most common musculoskeletal injury in sports across all populations1. Although most people believe that ankle injuries will spontaneously heal with rest in a few weeks, up to 45% of individuals report not having a full recovery at one-year post injury, and 1/3 report spraining their ankle again2. With 2/3 of ankle injuries not healing within 12-months, this leads to what is termed ‘chronic ankle instability’, characterised by feelings of giving way, weakness and instability as well as recurrent ankle sprains from the time of injury3.

With this knowledge in hand it is important that once you sprain an ankle, you don’t delay in seeing a physiotherapist and beginning your rehabilitation as early as possible. Up to 50% of individuals do not seek medical attention following injury and this is a primary reason why individuals develop chronic ankle instability4. Early and targeted physio has shown to decrease the risk of further ankle sprain by 47%5. Physio’s will seek to alleviate early pain and restore you to normal function as soon as possible, as well as addressing any modifiable risk factors (shown in figure 1.) for further ankle injury.

Ankle injuries usually occur on the lateral (outer) aspect of the ankle and injure one of three ligaments in this area; anterior talofibular (ATFL – most common ligament injured), posterior talofibular (PTFL) and calcaneofibular (CFL). These ligaments are primary hurt when you roll the ankle/foot outwards, stressing and over-stretching these ligaments until their breaking point (this is called an inversion injury (figure 2.)). The severity of the ankle injury can be assessed by a physiotherapist, and are graded as;

Grade 1 – stretching and slight tearing of the ligaments with mild tenderness and swelling. May be able to walk with slight pain.

Likely recovery 0-3 weeks with appropriate rehab  Grade 2 – a larger but still incomplete tear of the ligaments with moderate swelling, bruising and pain with walking. May have some feelings of instability

Likely recovery 3-6 weeks with appropriate rehab Grade 3 – a complete rupture of the ligaments with severe swelling and bruising. The ankle may feel unstable and walking is often not possible due to instability and intense pain

Likely recovery up to 12 weeks with appropriate rehab

So how can physiotherapy improve your return to function and reduce the chance of re-injuring your affected ankle?  The treating physiotherapist will provide a comprehensive assessment, identifying the severity of injury and any associated deficits. Following this, a treatment approach which is both goal-directed and specific to each injury will be employed, which may include; manual techniques, strengthening specific muscle groups, gait re-training, jumping and landing mechanics, balance and proprioceptive training and range of motion exercises6,7,8. Along with this, we will also implement sport specific drills and work with you through a graduated return to your chosen sport, ensuring a smooth re-integration. As we work through the rehab we will continue to modify the treatment if need be and get you back to your goals as soon as possible.

References

Doherty, C., Bleakley, C., Holden, S., & Eamonn Delahunt. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, (2), 113.van Rijn, R. M., van Os, A. G., Bernsen, R., M. D., Luijsterburg, P. A., Koes, B. W., & Bierma-Zeinstra, S. M. A. (2008). What Is the Clinical Course of Acute Ankle Sprains? A Systematic Literature Review. The American Journal of Medicine, 121(4), 324–331. Gribble, P. A., Delahunt, E., Bleakley, C., Caulfield, B., Docherty, C., Fourchet, F., … Wikstrom, E. (2014). Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. British Journal of Sports Medicine, (13), 1014.Vuurberg, G., Hoorntje, A., Wink, L. M., van der Doelen, B. F. W., van den Bekerom, M. P., Dekker, R., … Kerkhoffs, G. M. M. J. (n.d.). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. BRITISH JOURNAL OF SPORTS MEDICINE, 52(15), 956–+.Bahr, R., Lian, Ø., & Bahr, I. A. (1997). A twofold reduction in the incidence of acute ankle sprains in volleyball after the introduction of an injury prevention program: a prospective cohort study. Scandinavian journal of medicine & science in sports, 7(3), 172-177.Grimm, N. L., Jacobs Jr, J. C., Kim, J., Amendola, A., & Shea, K. G. (2016). Ankle injury prevention programs for soccer athletes are protective: a level-I meta-analysis. JBJS, 98(17), 1436-1443Friel, K., McLean, N., Myers, C., & Caceres, M. (2006). Ipsilateral hip abductor weakness after inversion ankle sprain. Journal of Athletic Training, 41(1), 74Dingenen, B., Malfait, B., Nijs, S., Peers, K. H., Vereecken, S., Verschueren, S. M., ... & Staes, F. F. (2016). Postural stability during single-leg stance: a preliminary evaluation of noncontact lower extremity injury risk. Journal of Orthopaedic & Sports Physical Therapy, 46(8), 650-657.

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