An ankle sprain is the stretching or tearing of the ankle ligament(s) due to the ankle “rolling” out of its neutral position. Ankle sprains are very common and happen to over 2 million Americans annually. It is estimated that there are about 2-7 acute ankle sprains occurring in every 1000 people. Ankle sprains can cause disability, with up to 70% of people who sprain their ankle developing a physical disability. In more severe cases, an ankle sprain can cause chronic ankle instability (CAI). Ankle sprains are most common in those who play sports, such as basketball. In fact, in the NBA, every 3 in 1,000 players sprain their ankle.
Ankle ligaments can become sprained easily. The most common type of an ankle sprain is a lateral ankle sprain or a sprain to the ligaments on the outside of the ankle. There three that hold the bones of the ankle together (the ATFL, CFL, and PTFL). The second most common sprain is to the ligament on the inside of the ankle (i.e., a sprain to the deltoid ligament).
There are 3 grades of ankle sprain. Grade 1, Grade 2, and Grade 3. A Grade 1 sprain is a mild sprain; there is a stretch or slight tear of the ligament. Mild tenderness, little swelling, some stiffness, and a little pain is experienced. The ankle is still stable, and walking is possible. A Grade 2 sprain is a moderate sprain. This is when there is an incomplete or partial tear to the ligament. Side effects of this type of sprain include moderate pain, swelling and bruising. Walking becomes more painful. The last type of ankle sprain is a Grade 3 sprain. This sprain is the most severe. It is accompanied by severe swelling, pain, and bruising. The ankle is unstable and walking or weight-bearing is no longer possible without pain. Typically, this grade of sprain requires a doctor or ER visit and an assistive device like crutches may be prescribed.
There are risk factors that increase the chances of one spraining their ankle. These risk factors include:
- Playing sports that include increased jumping or rolling/twisting of the foot like basketball, tennis, football, and soccer.
- Not wearing the proper shoes when doing activities or wearing shoes that are inappropriate for the activity. For example, running shoes should be worn when going jogging/running. This also includes wearing high heels
- Previous ankle injury
- Walking, running, jogging, etc. on an uneven surface
- Weak ankle muscles and reduced flexibility
- Being overweight.
The main causes of ankle sprain include:
- Twisting the ankle while falling
- Landing awkwardly on your feet after jumping/pivoting
- Someone else landing on your feet (especially during sports)
- Walking, running, or jogging on an uneven surface.
The symptoms of ankle sprain include:
- Pain (especially when standing/walking)
- Loss of movement around the ankle
- Tenderness to the site of injury
- Instability of ankle joint
- “Popping” sound at the time of injury
If one experiences any of these symptoms, they can get diagnosed by a doctor. The doctor will perform a physical exam, and evaluate the ankle for swelling, pain, and loss of range of motion. The doctor will also utilize X-Ray technology to differentiate a sprain from a strain. If the doctor notices that the condition is not improving, they may request an MRI to be taken as well.
Treatment of ankle sprain usually rarely involves surgery; surgery may be required only in severe cases. Usually, those who suffer from ankle sprains respond well to conservative measures like physiotherapy. A physiotherapist can use kinesiotape to reduce the pain and swelling caused by edema in those with ankle sprains. Also, a licensed physiotherapist can perform MLD treatments which are special treatments designed to increase the uptake of lymphatic fluid and reduce swelling. These treatments have a pain-relieving effect and can be used in conjunction with kinesiotape for an enhanced result. Physiotherapists can also design specialized exercise programs that focus on the strengthening and stretching of the ankle ligaments and muscles. This will restore prior function. The exercise program can also focus on improving coordination and sports specific training. Lastly, treatment can include self-care routines like R.I.C.E. Rest, Ice, Compression, and Elevation. This routine is great at reducing pain associated with ankle sprain and swelling.
Ankle sprains can be very common and very painful. Here are some ways, however, to avoid ankle sprain:
- Warm up before exercise/sports
- Continuously challenge the ankle muscles to get stronger
- Wear appropriate shoes
- Improve flexibility by stretching
- Avoid sky-high-heels
- Use an ankle brace/tape when doing prolonged or strenuous activities if previously injured.
- Proceed with caution on uneven surfaces
- Don’t be a “weekend warrior”. Condition your body appropriately when doing your sport of choice.
- Do stability exercises for the ankle and balance activities.
Although ankle sprains are common, they are also preventable and treatable. Consider some of the above options if you ever find yourself with an achy ankle.