Preventing Recurrent Ankle Sprains
Ankle sprains are very common sporting injuries, especially when that sport involves jumping, pivoting and twisting. Ankle sprains also occur throughout day to day life when walking on uneven surfaces, missing a step or tripping. The most common type of ankle sprain occurs when the foot rolls in underneath the leg causing tearing or strain to the ankle ligaments and resulting in outer ankle pain, swelling and bruising.
Our ligaments are strong fibrous connective tissue that connect bones to each other and stabilise joints. Ankle ligaments also play a huge role in our balance and tell us how our ankle is positioned; is it straight, on level ground, turned in or out?
Symptoms of an ankle sprain vary depending on the severity of ligament damage. Typically, it will involve a sudden sharp pain that makes it difficult to walk normally. For most ankle sprains, you should be able to walk afterwards albeit with pain and maybe a limp. The inability to weight bear following a sprain can be a good indicator of an ankle fracture and early medical review is recommended to rule this out. Swelling and bruising will often follow quickly and the ankle can be tender to touch and painful to move in all directions.
Ligaments will normally take 6-12 weeks to fully heal. The length of recovery however can differ due to the severity of injury. For example, a grade I ankle sprain, where the ligament is strained with minimal tearing, will recover quicker than a grade II (partial ligament tear) or grade III (complete ligament tear) ankle sprain.
Early ankle sprain management should include RICE (rest, ice, compression, elevation). Treatment will then normally include soft tissue work and joint mobilisation to promote healing and ankle movement and prevent scar tissue formation. Following this, management includes progressive strength and conditioning, balance retraining and return to sports specific exercise.
One risk factor following an ankle sprain is the recurrence of repeated sprains. Recurrent ankle sprains have been reported to occur in 40-70% of individuals after injury (Sefton et al 2011). The biggest reasons for recurrent ankle sprains are inadequate healing or a poor rehabilitation in balance and ankle postural control. Without this the ankle can give way often, further stretching and straining the injured ligaments, leading to chronic ankle instability and recurrent strains.
Balance and ankle postural control retraining involves performing exercises that test and improve your balance and ankle stability. This helps to promote ligament healing, joint stabilisation and ankle position sense. Stability exercises that are targeted to individual activities help strengthen the ankle for return to sport, reducing the risk of recurring ankle sprains and the development of chronic ankle instability.
Two examples of balance exercises post ankle sprain are:
- Standing on one leg aiming for 30 seconds without losing your balance. Progress to throw and catch a ball against the wall.
- Stand on a bosu or wobble board to challenge your balance. Progress to a mini squat or a single leg stance. You can begin to reach away from your body in different directions challenge your ankle further.
References
Sefton et al (2011). Six Weeks of Balance Training Improves Sensorimotor Function in Individuals With Chronic Ankle Instability. Journal of Orthopaedic & Sports Physical Therapy Vol 41(2).