Your Guide to Ankle Sprains
This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio & follow the steps to your full recovery. Understanding the goals of your treatment & having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
An ankle sprain is a common injury & usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle.
Ligaments are tough bands of tissue that help connect bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. They are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), & the posterior talofibular ligament (PTFL).
Grade 3 tears are a complete rupture of the muscle with severe pain, swelling & you may be able to feel a gap in the muscle fibres. Walking will be difficult & you may require crutches due to pain.
Initially the ankle is swollen, painful & may bruise. The bruising & swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain. Incomplete rehab following an ankle sprain usually means that the ankle will be sprained again in the future & if the ankle keeps turning in with activity, the condition is called ankle instability. This often produces swelling around the ankle that doesn’t go away. Pain & swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way.
A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. Tears can be either partial (part of the ligament is torn) or complete (all fibres torn, called a rupture). The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched & possibly torn.
What Happens If I Don`t Fix My Ankle?
The best results after an ankle sprain occur when treatment begins straight away. If the ankle ligaments do not heal adequately the ankle may become unstable, causing the ankle to give way & feel untrustworthy on uneven surfaces. This is because the ligaments become weaker after injury (even when the pain goes away) & without proper rehabilitation, respraining the ankle is very likely. People who have had several mild ankle sprains or one severe sprain may develop irritation & thickening of the ligaments that were sprained causing them to get pinched near the edge of the ankle joint on certain movements. Incomplete rehab will prevent you getting back to previous levels of exercise, sport & normal activity.
How Long Does It Take To Get Fully Better?
This depends on how severely you have injured your ligaments & what type of activity you are trying to return to. A full rehab program for mild to moderate sprain may take 8-10 weeks to return to normal strength & proprioception,
Your journey to peak performance with Central Physio
Your physio has been extensively trained to thoroughly assess & diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order & timing of the phases are tailored individually for you & so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Phase 1: Clarify Diagnosis
Sometimes the pain, swelling & bruising that may be present with acute ankle injuries mean that we are not able to do all of the testing we need to for your ankle in your initial treatment. Also, more than one structure in your ankle may be damaged, producing pain, so this needs to be clarified to give you an accurate diagnosis & management plan.
If you are unable to put weight through your foot due to pain, an x-ray may be required to rule out a fracture within one of the bones. Other investigations such as an MRI can show damage to the cartilage.
Phase 2: Optimise & Control Inflammation
Inflammation is the redness & swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Reducing the initial swelling associated with ankle injuries is one of the first big goals of your rehab. The time it takes for this depends on many things such as the severity of your injury, your age, damage to other structures & how quickly you start the correct treatment.
Your physio will use techniques including massage to help reduce your swelling, ice, stretches & specific muscle releases for your calf muscles to regain your flexibility. They may also mobilise your ankle joint to help restore full mobility.
Phase 3: Restore Range Of Motion
As your inflammation resolves it is important that you regain full range of motion in your ankle. You will need this to be able to walk & move normally, & it is the next big goal of your rehab. There are 4 movements your ankle performs – forwards/ backwards & side to side. It is important to restore each of these movements.
Phase 4: Improve Muscle Strength
In order to prevent the ‘rolling’ of your ankle again, it is important to strengthen the muscles that will help keep your ankle stable. Research has conclusively shown that this is especially important for the group of muscles called your peroneals. They run down the outside of your lower leg & are vital in stopping your ankle rolling in & causing re-injury.
Your physio will give you a number of different exercises using your body weight & theraband to strengthen the muscles around your ankle. They will start very gently & gradually become harder, & need to be done without aggravating your pain.
Phase 5: Proprioception Retraining & Functional Strengthening
Proprioception is your body knowing where it is in space. When you injure a ligament you lose a part of the proprioceptive mechanism for your ankle. It is very important that you retrain it because it is essential for returning to sport & preventing re-injury. Integrated with your proprioception retraining is basic functional strengthening. This involves making sure that the right muscles are being used with the right co-ordination & activation patterns to keep your ankle in the correct alignment during normal weightbearing activities & positions.
Phase 6: Sports/Ballistic & Advanced Strengthening
This is the last phase of your journey to full recovery. When you are returning to your activity you must be able to do it at full speed & resistance before being back in the game. You need to be able to apply your speed & force with the correct technique in training first to prevent another injury. In this phase we tailor exercises specifically to your activity by doing advanced sports-specific strengthening & high speed movements combined with rapidly changing directions. This phase is essential both for getting your back to your full level of performance, & also for preventing re-injury due to persisting background weakness or reduced co-ordination of muscle contractions.
Many clients find that seeing one of our Exercise Physiologists, Strength & Conditioning coaches or Personal Trainers is a great way to build strength, ability & confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability & strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer & reducing your risk of future injury.
For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.