Ankle Sprain Explained: A Physiotherapist’s Perspective

Physiotherapists Treat Ankle Sprains More Than You Think

“Rolling an ankle” is extremely common and if you have never rolled it, chances are you probably know someone who has. There's usually a bump on your foot that appears soon after. But what you don’t see is what happens underneath the bump. How severe is the injury? How long does a sprained ankle take to heal? How do you know if you sprained your ankle? This blog post will dive into an ankle sprain so you can understand what to look out for and when to see a physiotherapist.

Understanding How An Ankle Functions and What It Means for Physio Treatments

The body has passive supportive tissues otherwise known as ligaments, and their purpose is to support different joints and provide stability throughout the joint’s range of motion. A ligament sprain happens when the joint is forced past its natural range of motion.

 

Some examples of when ankle sprains may occur include stepping down from a curb or step, landing from a jump, or rapidly changing directions when playing sports.

The common mechanism for a rolled ankle is a combined movement of plantar flexion (foot points down) and inversion (bottom of the foot turns in). Commonly affected ligaments are on the lateral (outside) of the ankle including the anterior talofibular ligament (ATFL), the calcaneal fibular ligament (CFL), and in some instances the posterior talofibular ligament (PTFL). In rare instances, a rolled ankle outward can affect the medial (inside) deltoid ligaments. That means the ankle doesn't "look right."

In some cases, there may be more than a sprained ligament. If the forces are high enough (like jumping off a step), an avulsion fracture may occur where the ligament pulls on the bony attachment causing a piece of the bone to detach.

Symptoms of a Sprained Ankle

  • Severe pain
  • Bruising
  • Swelling
  • Decreased range of motion
  • Limited strength
  • Inability to walk

How To Identify A Sprained Ankle

How do physiotherapists know if you’ve sprained your ankle? The Ottawa Ankle Rules help physiotherapists determine just how bad an ankle sprain is. There are 5 components to look out for (see image below).

diagram-ottawa-ankle-rulesA. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
B. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus
C. Bony tenderness at the base of 5th metatarsal
D. Bony tenderness at the navicular
E. Inability to bear weight both immediately after injury and for 4 steps during initial evaluation

The Ottawa Ankle Rules are a quick and easy way to scan for potential fractures within the ankle. For examples:

  • If components A, C, and E are present, there is a chance of a fracture on the lateral side, which is outside of the ankle.
  • If B, D, and E are present, there is a chance of a medial ankle fracture.
  • If the former is present after a rolled ankle, it would be a good idea to get some imaging done and consult with an orthopaedic surgeon to discuss the following steps.
  • If none of the above causes pain and weight bearing is tolerable, then visiting a physiotherapy for rehab exercises would be ideal to optimize recovery.

Grades of Injury

If a fracture has been ruled out, the next steps for a physiotherapist would be to determine the extent of the sprain. There are 3 different grades of an ankle injury:

  • Grade 1
    • Microscopic structural damage
    • Local tenderness
    • No loss of joint stability
  • Grade 2
    • Partial rupture of ligament(s)
    • Swelling and tenderness
    • Little to no loss of joint stability
  • Grade 3
    • Full rupture of ligament(s)
    • Significant swelling
    • Loss of joint stability

In addition to the Ottawa Ankle Rules, there are other special tests the physiotherapist can perform to determine the extent of the injury. Following the initial assessment, the physiotherapist will determine the next steps of your recovery, to help manage your symptoms and to begin some exercises appropriate to the stage of healing.

You've rolled your ankle... now what?

In most scenarios, ankle sprains will follow the body’s natural course of healing. Some things that can be done to facilitate this recovery include:

1. Decrease swelling
2. Gentle pain-free range of motion
3. Banded exercises
4. Body-weight exercises – when appropriate
5. Balance and proprioception exercises
6. Improving/maintaining strength and range of motion in the adjacent areas of the foot and knee

How long does a sprained ankle take to heal?

It depends on the severity listed above, but ligament healing time is generally 6 weeks to 3 months. Gradual return to activities would be expected throughout the process. The key is to begin the recovery process as soon as possible to help strengthen and prevent recurrent ankle sprains.

Prognosis

Almost everyone will return to their daily activities, sport and recreation with little to no issues. Your physiotherapist can provide you with graded exercises to help strengthen the tissues and improve the tolerance to your activities. Occasionally, a patient may experience chronic and recurring ankle sprains. However, with the proper treatment and continuation of home exercises, the risk of chronic pain is low. A home exercise program is beneficial as it improves outcomes and prevents recurrent ankle sprains, allowing the patient to return to a normal lifestyle. The key is to start the recovery process as soon as possible.

As always, as physios, we always recommend prevention. Make sure to warm up before physical activity, and don't hesitate to reach out if you have any nagging ankle pain.


The Physio Shop specializes in evidence-based physiotherapy and massage therapy in a sweet commercial drive clinic, with a friendly barbershop feel. Plus, we do virtual sessions too, because 2020 right? If you’re dealing with nagging aches and pains, schedule a session with our finest Physiotherapists or Massage Therapists today. Or stop by and say hello to Sophie, that works too.

References
Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008 Sep-Oct;43(5):523-9. doi: 10.4085/1062-6050-43.5.523. PMID: 18833315; PMCID: PMC2547872.

Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, Kivlan BR, Carreira D. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021 Apr;51(4):CPG1-CPG80. doi: 10.2519/jospt.2021.0302. PMID: 33789434.

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