In this blog post, Shane Brennan, chartered physiotherapist at Mid West Physiotherapy, and specialist in foot and ankle issues, goes through the most common questions that patients have regarding ankle sprains. The good news is that ankle sprains are very treatable, and with the right approach you will enjoy a full and enduring recovery.
What is an ankle sprain?
An ankle sprain occurs when we overstretch the ligaments of the ankle. There are several ligaments in the ankle all of which are very strong, providing a lot of stability to the foot and ankle as we walk or run. They are most often injured when there is a twisting injury in the foot. Ligaments can tear, but this usually requires a higher force of twisting injury, or repeated sprains. For the purposes of this blog, I will be talking about injury to the lateral ligaments in the ankle, which are most commonly injured.
Why does my ankle hurt?
The purpose of a ligament is to prevent excess movement in a joint. If we move in a way that causes excess movement in a joint, or if have an injury that puts these ligaments under stress, the ligament tissue can stretch slightly – this causes a pain reaction in the body. Often with ankle ligament injuries, this pain can be accompanied by bruising and swelling.
Do I need an X-Ray?
One of the most common questions I get asked is whether an X-Ray is needed after an ankle sprain. People can sometimes hear or feel a “crack” or “pop” and think that means that something is broken. Often an X-Ray is not needed. It is important to get assessed by a medical professional soon after the injury to determine if an X-Ray is needed. If you are worried that you may have a bony injury in the ankle but are unsure whether an X-Ray is needed, make an appointment to see us in clinic where we can assess and advise you. A general rule of thumb is that if you can put weight on the foot for 4 steps, you are less likely to have broken anything.
What can I do today to make it better?
There are a lot of options in terms of managing an acute sprain in the ankle. Luckily, there is high quality scientific evidence, suggesting the following approach is best:
- Protect and Optimal Loading – Optimal Loading means progressively increasing the weight we put on the ankle as pain allows. In short – it means rest is not best when it comes to rehabilitating an ankle sprain. In some instances, we may need to protect the ankle to allow us to walk on it – using crutches, taping or bracing.
- Therapeutic Exercise – (1) Gentle movement of the foot and ankle – even if it is slightly painful, will help with recovery. (2) Balance practice & rehabilitation once pain allows
- Hands-on Physiotherapy – There is good evidence that hands on physiotherapy, along with therapeutic exercise, is beneficial to reduce swelling, improve pain-free ankle and foot mobility, and normalise gait.
- Others – Other things, which were once a mainstay of managing an ankle sprain – such as ice, elevation & anti-inflammatories, are no longer recommended as the best approach. However, they may help some people to walk a bit better after an ankle sprain.
Will I have to stop exercising?
For the first week or so after your injury you may need to change the way you exercise – cycling or swimming would be preferable to running – but with good immediate care you should be back up and running before long.
When will I get back to sport?
Depending on your sport, and the degree of sprain in the ligaments, you can expect to return to sport within 1 to 3 weeks. The people I see who have the best outcomes following ankle sprain are those who get physio early & get walking on it as soon as possible.
References
This blogpost was created using evidence from the following clinical practice guideline: Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision
Robroy L. Martin, Todd E. Davenport, John J. Fraser, Jenna Sawdon-Bea, Christopher R. Carcia, Lindsay A. Carroll, Benjamin R. Kivlan, and Dominic Carreira
Journal of Orthopaedic & Sports Physical Therapy 2021 51:4, CPG1-CPG80
