FAQ: Lateral ankle sprain
06/05/24What is a lateral ankle sprain? A lateral ligament sprain is often a product of you rolling over your ankle and putting weight (force) down through the ankle joint at the same time. Movement of the ankle inwards (referred to as inversion of the ankle) causes stretching/tearing of the muscles, ligaments, and the joint capsule on the outside (or lateral) side of the ankle. The picture below highlights the most common ligaments stretched with this type of movement. The most common ligament injured in a lateral ankle sprain is the anterior talofibular ligament (known as the ATFL) which is the ligament on the front/outside of the ankle.
Source: https://motusspt.com/lateral-ankle-sprain/
Where will I feel pain? You will most likely feel pain on the front/outside of the ankle around the protruding bone on the outside of your ankle. This is where many of the ligaments attach on the outside of the ankle – therefore, this is the most common site of pain. However, it is also common to have pain at the front of the ankle joint and running up the outside of the ankle/lower leg. Pain at the front of the ankle joint is often from disruption to the joint capsule itself + with increased swelling causing pain upon movement of the ankle joint forwards and backwards (its most common movement). Pain on the outside of the ankle up the outside of the leg is often associated with stretching of the muscles that traverse on the outside of the ankle.
What movements will I struggle to perform if I have a lateral ankle sprain? Lateral ankle sprains are graded from 1-3 based on their severity, with 3 being the most severe (see image below for an illustrative overview of the stages). This is based on the damage to the ligamentous tissue and how much stability remains in the ankle after the acute injury.
Source: https://kidzoles.com/blog/ankle-sprains-in-children
Increased severity and swelling will reduce your ability to complete all movements of the ankle. However, if only minor damage has been incurred then only movements of the ankle inwards and outwards (inversion and eversion) will be painful.
Will I feel pain in any other regions of my body? It is common to feel referred pain down into the foot or up into the calf following this injury. These aches and pains are likely referrals from the structures that are damaged but can also be associated with the reduced movement following the injury. However, pain is likely to be localised to the outside (lateral side) of the ankle.
What things should I try initially once I’ve hurt myself? Historically the advice has been to apply ice to the area and rest for as long as it takes to feel better in the ankle. Whilst ice can still be used, it is not required to obtain a full recovery from this type of injury. Our osteopath, Ash, wrote a great blog on PEACE & LOVE, which stands for Protect, Elevate, Avoid anti-inflammatories, Compress, Educate, Load, Optimise, Vascularise, Exercise – all are significantly important steps for the rehabilitation of a lateral ankle sprain.
Compression and elevation are a must initially. Then retraining walking + ankle movements as tolerated is the best progression through the initial stages of the rehabilitation process.
What things should I try to avoid in the initial stages of injury? Avoid anti-inflammatories initially – as the body does need to go through an inflammatory period to heal the damaged tissues. By disrupting this phase initially, it can cause issues with the intrinsic healing capacity of the body.
It is also a great idea to avoid continual loading and flaring up the ankle – this includes causing increased swelling. This will prolong the rehabilitation phase and cause further damage before the body can heal itself.
What type of exercises or movements do I need to learn/control/be stronger at to rehab the injury? Restoring ankle range of movement is very important to help fast-track recovery. The following progressions are commonly used throughout the rehab of a lateral ankle sprain:
- Isolated resisted ankle movements with a theraband
- Return to walking
- Balance tolerance (standing on one foot with eyes open, then eyes closed)
- Calf raise tolerance
- Then, once ready: return to impact exercises – jumping, hopping etc.
These targets are specific to the ankle. However, focusing on other joints/muscles of the lower limb is also very important throughout the rehabilitation process.
What other considerations contribute to the injury? Previous ankle injuries or other lower limb injuries on one side can predispose the ankle to this type of injury. A lateral ankle sprain is commonly found when a person is fatigued – i.e. towards the end of an athletic bout when their system is not fresh to control foot placement and/or ankle control.
Furthermore, this injury can be exacerbated when a person is very stiff through their ankles. Therefore, consistent mobility of the ankle and lower limb joints can help to prevent the severity of a lateral ankle sprain. Please book in for a consult with one of our clinicians if you are interested in learning the types of exercises to perform to help reduce the chance and severity of these injuries.
What treatments can help relieve some pain or fast-track my rehabilitation? Soft tissue release around the foot and calf can help in the acute phase of rehabilitation to promote the body to flush out any swelling. However, loading of the ankle as tolerated will help the body to retrain the supportive muscles and to fast-track regaining function in the ankle.
What are the expected timeframes of rehabilitation? A typical grade 1 lateral ankle sprain will take anywhere from 1-4 weeks to recover – this will be dependent on previous history and the target exercise level to return to.
A grade 2 sprain usually requires anywhere from 4-8 weeks to recover with adequate loading and rehabilitation exercises.
A grade 3 can take approximately 12 weeks to recover and depends on adherence to exercise routines and reloading strategies.