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Understanding Ankle Sprains

What is an Ankle Sprain?

​Ankle sprains are common injuries that occur when the ligaments around the ankle are stretched or torn due to sudden twisting or rolling of the joint. They are frequent among athletes but can happen to anyone during daily activities.

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What happens during an Ankle Sprain?

The ankle’s stability comes from ligaments connecting the bones. The most commonly injured ligament is the anterior talofibular ligament (ATFL). The timeline for recovery depends on the severity of the sprain and adherence to treatment. Sprains are classified into three grades:

  1. Grade 1 (Mild): Slight ligament stretching or microscopic tearing.

    • Recovery: Typically, 1–2 weeks. Patients can resume activities gradually with focus on range of motion and strength.

  2. Grade 2 (Moderate): Partial ligament tear, with noticeable swelling and difficulty bearing weight.

    • Recovery: 3–6 weeks. Physiotherapy emphasizes swelling reduction, mobility restoration, and joint strengthening.

  3. Grade 3 (Severe): Complete ligament tear, resulting in instability and significant pain.

    • Recovery: 8–12 weeks or longer, especially if surgery is required. Rehab includes strengthening, stability exercises, and functional training.

Progression Milestones during Physiotherapy

  1. Weeks 1–2: Pain and swelling control with gentle range-of-motion exercises.

  2. Weeks 3–4: Gradual strengthening and balance training, with increased weight-bearing.

  3. Weeks 5–8: Advanced strengthening, dynamic balance, and sport-specific exercises.

Beyond Week 8: Full return to activity, depending on pain-free mobility and stability.

Treatment Phase 1
(Initial 1 - 2 Weeks)

Initial care for sprains involves the PEACE & LOVE protocol (Dubois and Esculier (2019) - 

 

Phase 1: (Initial 1-2 weeks depending on grade of sprain)

  • Protect: Avoid activities that aggravate the sprain, however, continue to move and weight bear within your pain tolerance levels. Prolonged rest can increase the difficulty to return to your prior strength. 

  • Elevate: Elevate the ankle higher than the heart, this helps to move excess fluid away from the injury.

  • Avoid Ice and anti-inflammatories (NSAIDs): This is a complete turn around from decades of previous advice. But recent research has shown that these may negatively affect long term tissue healing. This may not always be the case as there are some circumstances where Ice and NSAIDs are still warranted. Check with your Physio or health care provider to find out more. 

  • Compression: Use an elastic bandage to reduce swelling, should still have full movement of the ankle.

  • Education: Seek information from your Physio or health care provider about: Appropriate load management, the expected timeline of your sprain, what they are looking for to decide if further investigation is needed.

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Treatment Phase 2 

  1. Phase 2: (As guided by your Physio – generally begins within 1 month since injury depending on grade of sprain)

  2. Load: Optimal loading that doesn’t increase pain helps promote tissue repair and builds tendon and ligament tolerance and capacity.

  3. Optimism: Staying positive about your recovery will help mentally and has been shown to have positive effects on healing time. Your Physio or health care provider should stay in close communication with you throughout the healing process and into Rehab and return to sport/work/school. 

  4. Vascularisation: Cardiovascular exercises help to promote blood flow and improve function, there is also evidence that they can reduce stress and the need for pain medication.

  5. Exercise: The appropriate exercises and progressions provided by your Physio will restore mobility, strength and proprioception after your injury.

Physiotherapy is crucial for full recovery

  • Pain Management: Manual therapy, kinesiology taping, or ultrasound can help.

  • Restoring Mobility: Gentle exercises and stretches improve flexibility.

  • Strengthening: Target muscles around the ankle to support the joint and prevent recurrence.

  • Proprioception Training: Balance exercises like standing on one leg enhance stability.

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When should you go to the Emergency Room?

  1. While most ankle sprains can be managed with the help of a physiotherapist, urgent medical attention is necessary if you experience:

  2. Severe Pain: Intense pain that does not improve with rest or pain relief measures.

  3. Deformity: A visibly out-of-place ankle, suggesting a dislocation or fracture.

  4. Inability to Bear Weight: Complete inability to put weight on the injured ankle without severe pain.

  5. Numbness or Tingling: Possible nerve involvement or compromised circulation.

  6. Open Wounds or Significant Bruising: Signs of a compound injury requiring immediate care.

  7. Persistent Swelling or No Improvement: Worsening symptoms or no improvement after a few days.

Preventing Future Ankle Sprains

  • Preventing recurrent ankle sprains involves strengthening exercises, proper footwear, and, if necessary, bracing. Athletes may benefit from sport-specific drills designed by physiotherapists.

  • Ankle sprains, though common, should not be ignored. Timely treatment and physiotherapy are essential for recovery and to avoid chronic issues like instability or arthritis. Consult a healthcare professional if symptoms worsen or you’re uncertain about your recovery progress.

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