Ankle Sprain

It’s happened to almost everyone. One wrong step and you might find yourself on the ground holding your ankle. Actually, an ankle sprain is the most common injury in the athletic population. Since it’s so common, it’s important to understand what it is and how to take care of it.

What is an Ankle Sprain?

The ankle is a complex joint comprised of the tibia, fibula, and talus. Many ligaments help to connect one bone to another bone in order to give the ankle stability. There are ligaments on both the inside and the outside of the ankle. The most commonly injured of these ligaments is the anterior talofibular ligament.1 This ligament sits toward the outside and the front of the ankle and attempts to prevents the ankle from falling inward.

An inversion ankle sprain is the most common form of ankle sprains.1 These types of sprains occur when the foot falls inward and the ankle rolls outward Eversion ankle sprains (the foot rolling outward) are less common due to the fact that the fibula helps prevent this motion. Ankle sprains can also occur when the ankle is pointed or flexed beyond its normal limits.

Sports Commonly Associated with Ankle Sprains:

Ankle sprains can occur in any sport, which is one of the reasons they are some of the most common injuries. Ankle sprains occur most commonly when an athlete is performing on unstable surfaces. Ankle sprains are common in soccer, football, sand volleyball, lacrosse, field hockey, gymnastics, and trail running.

Causes:

Ankle instability is the main cause of ankle sprains. While ligaments work to limit movement, sometimes ligaments become relaxed and cannot perform their normal function. Additionally, after one ankle sprain, the ligaments have more laxity and the likelihood of chronic ankle sprains increases. About 1/3 of all first time ankle sprains become chronic due to the increase in laxity of the ligaments.[1]

In addition to instability of the ankle, uneven surfaces often lead to ankle sprains. Uneven surfaces force the ankle into positions that cause greater instability. Objects such as stray athletic equipment are also known for excessive sprains as athletes will step on the equipment and their ankle will be forced into an unnatural position.

Symptoms:

The symptoms of an ankle sprain are pain around the anterior talofibular ligament, pain when pointing the toes and pointing the toes inward. The athlete may report the sound of a pop when the injury occurred. There will be swelling and bruising all throughout the ankle.[1]

An ankle sprain will best be diagnosed with an MRI (magnetic resonance image). Ultrasound imaging may also be used in order to rule out other injuries. If the athlete is still experiencing pain after two to four weeks of treatment, the athlete should request an X-ray.

Prevention:

The best way to prevent an ankle sprain is to strengthen your ankles. While the job of ligaments is to prevent motion beyond the body’s normal limits, ligaments can stretch and fail. The musculature surrounding the ankle assists the ligaments in keeping the ankle stable and in the correct place. Strengthening can occur naturally by completing your sport or workout. It can also be done through specific exercises and workouts.

Another way to prevent ankle sprains is to tape your ankle. While many people do not advise taping your ankle for every workout because it hinders the natural strengthening process, taping your ankle for competition or only when exercising on unstable surfaces can prevent ankle sprains and therefore prevent laxity within the ankle capsule.

Treatment:

Modalities:

Modalities are especially important in the acute phase of an ankle sprain. The goal of the initial treatment plan is to decrease pain and inflammation. This can initially be done with ice in order to decrease cell metabolism. A contrast bath (switching the ankle from hot water to cold water) can help to create a nature pump within the body through the dilation and constriction of blood vessels. Additionally, an ACE-bandage can be applied to the area beginning the wrapping at the toes and move up passed the ankle.

Stretching:

Stretching should not be completed until pain is limited and most of the swelling has been removed from the area. Stretching of the ankle can be completed by looping a towel or strap around the ankle and pulling back toward the body. Stretching of the calf and muscles on the back of the leg should also be completed by stepping into a lunge and leaning into the forward foot.

Strengthening:

Strengthening after an ankle sprain can begin as soon as the athlete feels capable. The pain with strengthening should not be excessive, however, the athlete can begin very soon after injury. In the initial phases of strengthening the athlete can simply point and flex the foot slowly in order to strengthen and restore range of motion. As strengthening progresses the athlete can add some sort of resistance such as a Thera-Band and move the ankles in all directions. Finally, in the end stages of rehabilitation, the athlete can complete balancing exercises such as standing on one leg in order to increase strength and proprioception.

References:

1. Starkey, Chad, and Sara D. Brown. Examination of Orthopedic & Athletic Injuries. F.A. Davis Company, 2015.