Ankle sprains – why do we often treat ankle sprains as Insignificant injuries and is it time to change?

Establishing the number of ankle sprains that occur in the UK is difficult however what we do know is that ankle sprains are common musculoskeletal injuries in both athletes and sedentary people attending accident and emergency departments. We even know that around 55% of people who sprain their ankle do not seek assessment and or treatment from a health care professional.  This could be related to people’s perceptions of an ankle sprain as being a minor injury that generally settles with time and rest. However, untreated ankle sprains can have consequences as reported re-injury rate and residual symptoms are very high.

Following an ankle sprain did you know that the reoccurrence rate for a second ankle sprain is as high as 80%. It is also well documented that residual symptoms such as pain and instability following ankle sprains are reported in 30% to 40% of patients.  You may be asking why is this? Well, once you have sprained your ankle often stretching the joints, ligaments, tendons and neural tissue the mechanics (interaction of aforementioned structures) can change. 

Ligaments are strong tissues and their function is to provide joint stability, help control joint movement and provide proprioception. Proprioception is the awareness of where your body is positioned independent of vision. Once you have stretched a ligament they don’t always return to their original state and have slightly more stretch. This can lead to increased joint movement, reduced stability and proprioception. This places you more at risk of a second injury the more times you then sprain your ankle the more unstable it will become. This can lead to chronic pain, muscular weakness and recurrent giving way. All of which can have a significant impact on work, hobbies, leading to long term disability and reduced quality of life.

Factors responsible for poorer outcomes following an ankle sprain are reduced proprioception (awareness of where your joint is in space) and peroneal (muscle) weakness. Both can be assessed and improved with physiotherapy intervention.  We believe that early diagnosis, functional treatment and rehabilitation are the key to the prevention of chronic ankle instability and long term disability.

Ankle injury at Fay PedlerMechanism of injury

Over 90% of ankle injuries involve the ligaments on the outside of the ankle.  These ligaments are stretched when the ankle rolls outward and the foot turns inward. The two ligaments that are most affected include the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). The ATFL is affected in two-thirds of all ankle sprains and with increased force, the CFL is often inured.

So how do we grade ankle injuries?

Ankle injuries are often classified by health professionals in a minor injuries’ unit. The classification is dependent on the amount of damage sustained to the ligament, the surrounding capsule, degree of instability and reduced ability to weight bear (functional loss). The classification is graded into mild, moderate and or severe. 

Mild – defined as mild stretching (microtears) of the ligaments. There is minor swelling, no laxity and minimal functional loss

Moderate – defined as partial tears to the ligament, moderate swelling, some loss of movement and ability to weight bear. Laxity may be mild or may not be present.

Severe – defined as complete tear of the ligament, severe bruising, loss of movement and major loss of function ability to weight bear.

Two points to consider at this stage. Firstly, in the initial phase, it is difficult to assess for ligament laxity/tears immediately after an injury due to swelling and pain. It is therefore important to have the ankle re-examined once swelling has reduced which may take four to seven days. Secondly, if you notice bruising around the inside of the ankle after the injury this may indicate a more significant injury that involves structures within your ankle joint that will require greater recovery time.

Initial treatment for grade I/II sprains (1-3 days)

  • Protect – rest the affected ankle initially then start gently moving.
  • Optimal loading – this is gentle movement of the ankle joint slowly and progressively increasing the amount of your body weight through the affected leg when walking. This helps prevent muscle weakness and tightness.
  • Ice – this can help reduce pain in the affected area.
  • Compression – apply pressure to the area when applying ice.
  • Elevation – to help control the swelling.

Note – Anti-inflammatory medications are recommenced two to seven days following an ankle sprain.

After the initial phase, it is important to start improving your single leg balance and to strengthen the peroneal muscles on the outside of your foot. This can be achieved through purchasing a resistance band and or speaking to a Chartered Physiotherapist. During this stage of treatment, you can return to activities utilising taping or functional support to provide protection and stability, prevent further injury and allow the healing process to continue.

Fay Pedler Physiotherapy

Evidence suggests that early assessment, accurate diagnosis, functional treatment, and rehabilitation are the key principles to prevent ongoing problems following ankle sprain. At Fay Pedler physiotherapy clinic we would ideally assess your ankle within the first few days of injury. At this stage, you should be able to place weight through your ankle. If you are unable to bear weight (walk four steps) and you have bony tenderness, then you require an x-ray to rule out any bone injury/fracture.

At the initial appointment, we will be able to undertake a thorough examination of your ankle so that we can diagnose what structures have been affected. We will also look closely at your knees and hips to make sure that we maintain your lower limb strength and movement whilst the ankle undergoes the initial stages of recovery.

Once the assessment has been completed, we can talk through the structures that have been affected, rehabilitation principles and treatment options, goal setting and more importantly time scales for recovery.

At Fay Pedler physiotherapy clinic we don’t just want you to get better we want to prevent the problem from happening again.