Ankle Sprains are injuries which involve damage to the ligaments of the ankle. It is the most common sporting injury and usually occurs due to a twisting, rolling or abnormal movement of the ankle in weight bearing, such as running, jumping, or stepping on an irregular surface. They can vary in severity, from minor sprains to complete rupture of the ligaments. More severe cases will be accompanied by other injuries to structures around the ankle, such as to the bone, tendons or the surrounding muscles.

Which Ligaments Are Affected:

There are many ligaments in the ankle, and any one (or combination of them) can be injured, however, the most commonly affected ligaments, in up to 75 % of the cases, are the ones on the lateral side (outside) of the ankle.

These include the:

• Anterior Talo-Fibular Ligament (ATFL)
• Calcaneofibular Ligament (CFL)
• Posterior Talo-Fibular Ligament (PTFL)

The medial ligaments of the ankle (also known as the Deltoid Ligament) are much stronger, so they are less likely to be injured.

High ankle sprains to the syndesmosis or inferior tibiofibular ligament are less common than the typical ankle sprain, however, they tend to cause more significant impairment and disability.

Grading of Ankle Sprains

Grade 1: Mild

• Minor injury/stretching of the ligaments in the ankle
• Will take anywhere from a couple weeks to a month to heal
• Joint stiffness, ligament laxity (looseness), muscle weakness/tightness and poor motor control expected with mild sprains
• Adequate rest from physical activity will help the ligament repair naturally. However, physiotherapy is very important to help restore mobility, co-ordination and muscle strength, as impairment in any of these aspects can increase the chance of a reinjury later down the track. The chance of an ankle ligament reinjury are anywhere from 40-70%, so rehabilitation and physiotherapy is very important to reduce the chances of this recurrence.

Grade 2: Moderate

• Involves excessive/significant stretching of the ligaments
• Takes anywhere from 4-6 weeks to heal
• Injured ligaments may become very lax (loose)
• Physiotherapy is very important for grade 2 strains. It is similar to that of physiotherapy for milder injuries above but more emphasis may also be placed on power, agility, and sports specific skills/drills

Grade 3: Severe

• Complete rupture of the ligaments
• Recovery is expected to take 2-3 months
• Can also include fractures or high ankle sprains that make the injury more complicated
• As a result, the rehabilitation process is more complicated and tailor made to the person’s injury. There is a potential for surgery if rehabilitation is not successful. Initially conservative rehabilitation is recommended.
• As a result, the rehabilitation process is more complicated and tailor made to the person’s injury. There is a potential for surgery if rehabilitation is not successful. Initially conservative rehabilitation is recommended.

Symptoms:

• Cracking, popping, crunching sound at the moment of injury.
• Swelling, tenderness and bruising around the area, usually accompanied with pain
• For severe injuries (grade 3 tears), you may have trouble weightbearing (walking, standing). There may also be a very sharp, intense pain, indicating a potential fracture or high ankle (syndesmosis) sprain

Please note, indications for an XR may include: a crack/pop sensation at time of injury, bony tenderness, especially tenderness of the fubular, tibia, navicular or the 5th metatarsal, and the inability to take 4 steps. In these instances, you should consult a Doctor or Physiotherapist to check if an XR, CT or MRI is required.

RICE!

If you sprain your ankle, follow RICE immediately.

Rest from any aggravating activities to prevent further injury.

Ice the area for 15-30 minutes every couple hours during the day. Make sure the ice pack is placed on firmly, between a thin towel or cloth

Use a compression wrap, bandage or elasticated tubigrip on your ankle  to help reduce swelling. Note that it’s not meant to be a replacement for crutches or a walking boot.

Elevation of your ankle above the level of your heart while lying down will help to reduce swelling around your ankle

Physiotherapy for Ankle Sprains

1. Regaining Full Range of Motion: While physiotherapy helps provide pain relief and works on the recovery of your ligament, they will provide you with exercises to help with regaining your range of motion, muscle length and motor control while your ankle is inactive.
2. Muscle Strength: As you continue to regain co-ordination and mobility in your ankle, your physiotherapist will begin to prescribe exercises to improve the strength of your muscles, to improve the stability of the ankle and to help compensate for the stretched ligaments.
3. Restoring Power, Proprioception & Agility: Your physiotherapist will prescribe more exercises to help your ankle regain the function needed to return to your required level and type of activity. The exercises and program will depend on the your activities and requirements for return to sport/work. Regaining normal strength, balance and movement is imperative in preventing further ankle sprains. Poor proprioception/balance increases the risk of re-injury.

For return to sport taping or bracing is used to prevent re-injury especially early on till normal strength, proprioception and confidence is gained.

Cam walker boots may also be used initially for grade 3 strains to help immobilise the area, also for syndesmosis injuries and fractures of the foot or ankle.

Call us on 02 9412 4184 or email us at admin@chatswoodalliedhealth.com.au if you require an appointment for an ankle sprain or have any questions! We also stock cam walker boots, ankle braces and sports tape.