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Ankle sprains. An updated guideline

4th Jul, 2022

Key Points

  1. Ankle sprains are the most common foot and ankle injury when playing sports. 
  2. Physiotherapy after an ankle sprain is important to prevent future sprains and reduce the occurrence of chronic ankle instability.
  3. Physiotherapists will provide treatment which include guidance on gradual weight-bearing, an exercise program, manual therapy and ankle bracing or taping.

How often do ankle sprains occur?

You sprain your ankle when you awkwardly roll or twist your ankle. This results in swelling, pain and difficulty walking. It is estimated that 12% of people would experience an ankle sprain at least once in their lifetime. Of which, approximately 50% would seek medical attention. 

Ankle sprains are the most common foot and ankle injury when playing sports. 4 in 10 individuals sprain their ankle for the first time while engaging in sporting activities. Ankle sprains occur more commonly in individuals playing indoor or court sports such as volleyball and basketball compared to field sports such as soccer, football or rugby.

Ankle sprains occur most commonly in children aged 12 or younger, followed by adolescents aged between 13 and 17 years and lastly, in adults aged 18 years or older. Female athletes also have a higher incidence rate of ankle sprains, nearly double that of their male counterparts.

One year after the ankle injury, if a person continues to have problems walking or playing sports and feels like their ankle “gives way”, they are diagnosed with chronic ankle instability (CAI). CAI is common among athletes, especially females in the secondary or tertiary level athletes. 

What is the risk of recurrent ankle sprains?

Some risk factors for sustaining an ankle sprain include:

  • Female gender
  • Hip abductor and extensor weakness (big word for buttock muscle weakness)
  • Poor performance on balance and hopping tests
  • Participation in court sports

The risk factors for CAI are as follows:

  • Not using prophylactic bracing
  • Not participating in an exercise-balance program
  • Poor functional performance post-ankle sprain
  • Participation in sports
  • Higher body mass index (BMI)

How should you manage an ankle sprain?

Prevention of ankle sprain

Can you prevent ankle sprain? To prevent first-time ankle sprains, there is substantial research evidence supporting the use of prophylactic ankle braces. Bracing reduces the risk of ankle sprains and therefore is particularly important for those who possess the risk factors mentioned above. 

For those who have already sustained an ankle sprain previously, prophylactic bracing and balance training is important to reduce the risk of recurrent sprains. 

What should you do after an ankle sprain?

The use of external supports such as braces, taping and crutches are recommended for those with ankle sprains to allow progressive weight-bearing onto the injured leg. The type of external support and walking aid depends on the severity of the injury, phase of tissue healing, level of protection required, the extent of pain, and patient preference. For more severe ankle sprains,  immobilisation, ranging from semi-rigid bracing to below-knee casting, may be indicated for up to 10 days post-injury.

What type of exercises for an ankle sprain?

A structured therapeutic exercise program is recommended for individuals with ankle sprains. Exercise after an ankle sprain should be customised to fit the individual’s needs and goals, and is largely determined by injury severity, identified impairments, preferences, learning needs, and social barriers. They can be performed both in the clinic and at home. The exercise program would typically include:

  • Protected active range of motion exercises;
  • Stretching exercises;
  • Neuromuscular training;
  • Postural re-education; and
  • Balance training.

Manual therapy coupled with therapeutic exercise can provide benefits to those with ankle sprains by reducing swelling, improving pain-free ankle mobility, and restoring normal walking patterns. Examples of manual therapy techniques include lymphatic drainage, active and passive soft tissue and joint mobilisation, and anterior-to-posterior talar mobilisation procedures within pain-free movement.

Should I RICE my ankle sprain?

R.I.C.E (Rest, Ice, Compression, Elevation) is a common acronym taught as the first-line treatment for ankle sprains. However, strong evidence suggests that rest, ice, compression and elevation are insufficient for recovery in people with acute ankle sprains. A combination of intermittent icing and therapeutic exercise, rather, may help to improve load tolerance during weight-bearing, improving the ability of individuals to bear weight on the injured leg.

Chronic Ankle Instability (CAI)

In contrast to ankle sprains, external support such as braces and taping as the sole treatment is not recommended to improve balance and postural stability in individuals with CAI. Therapeutic exercise that targets the proprioceptive system and the neuromuscular system can improve dynamic postural stability, and therefore is recommended for individuals with CAI. Lastly, manual therapy to improve dynamic balance and weight-bearing ankle dorsiflexion is also beneficial for individuals with CAI.

When can I return to sport after an ankle sprain?

After sustaining an ankle sprain, a complete return to activity or sports can range from as short as a day or as long as more than 3 weeks. This is dependent on the demands of the desired activity or sport. Full recovery without symptoms or activity limitations, on the other hand, may take up to months or years. The relationship between injury severity and the extent of recovery has not been established given current research evidence.

If you develop CAI after the original ankle sprain, you may experience problems in your trunk, hip, knee, ankle and foot. This affects your ability to participate in activities such as sports and exercise. You may also have an increased risk for further injury.

Why do you need to see a Physiotherapist after an ankle sprain?

Although ankle sprains are very common within the sporting community, it is estimated that only 6.8 to 11.0% of people who seek medical care for their ankle sprains are referred to a rehabilitation specialist within 30 days of their injury. 

Through an exercise program and other procedures such as manual therapy, Physiotherapists can help avoid further complications of ankle sprains. A study conducted in 2018 found that early initiation of an exercise program can help prevent recurrent ankle sprains, reduce the chance of CAI developing and improve recovery time and outcomes. 

Exercise supervised by a Physiotherapist is also more beneficial for individuals with ankle sprains compared to unsupervised home exercises. Supervised therapeutic exercise improves ankle strength and proprioception, and encourages a faster return to activities.

What happens during a Physiotherapy session for an ankle sprain?

When you see a Physiotherapist for an ankle sprain or chronic ankle instability, he/she will conduct several tests to examine your ankle. This includes assessing:

  • Strength and movement of your ankles;
  • Balance when standing and moving;
  • How much weight you can bear; and
  • Hopping or jumping.

Your Physiotherapist would then proceed to treat your ankle sprain by providing:

  • Guidance on progressive weight-bearing on the injured ankle, using external supports like crutches if needed;
  • An exercise programme designed together with you to allow a faster recovery and prevention of future sprains;
  • Manual therapy to reduce swelling, and increase weight-bearing and ankle movement;
  • Ankle braces or taping to prevent future sprains, especially if you play sports.

Exercises help to improve your ankle strength, movement and balance after an ankle sprain. These exercises can be performed at the clinic or at home, and can include work- or sport-specific exercises to allow your return to your daily activities. You can start by standing on a pillow or piece of foam and progress to using a wobble or balance board to improve your balance. These simple balance exercises can also help to strengthen the muscles around your ankle and improve your ability to change direction while running or hiking over uneven terrain.

Unsure of what to do after an ankle sprain? Book now to speak to our Physiotherapist or Podiatrist who will be able to care for you and facilitate your recovery at the Rehab Centre

Ref:

Ankle Sprains: What Updated Guidelines Mean for You. (2021). The Journal of orthopaedic and sports physical therapy, 51(4), 161. https://doi.org/10.2519/jospt.2021.0504 

Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll, L. A., Kivlan, B. R., & Carreira, D. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision. Journal of Orthopaedic & Sports Physical Therapy, 51(4), CPG1–CPG80. https://doi.org/10.2519/jospt.2021.0302 

Vuurberg, G., Hoorntje, A., Wink, L. M., van der Doelen, B. F. W., van den Bekerom, M. P., Dekker, R., van Dijk, C. N., Krips, R., Loogman, M. C. M., Ridderikhof, M. L., Smithuis, F. F., Stufkens, S. A. S., Verhagen, E. A. L. M., de Bie, R. A., & Kerkhoffs, G. M. M. J. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine, 52(15), 956 LP – 956. https://doi.org/10.1136/bjsports-2017-098106

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