Ankle sprains (or rolling the ankle) are one of the most common musculoskeletal injuries in physically active populations, with the outside (lateral) part of the ankle frequently involved. Incidence rates in the general population are high, at an estimated five to seven injuries per 1000 people per year.
What can I expect with an ankle sprain?
In the first few minutes following the injury it is likely that you will experience pain, tenderness, swelling, and bruising. You may initially be able to walk and as the swelling increases you may have more difficulty. As the swelling increases and spasm sets in, you will have difficulty with normal motion of the ankle. This is all normal for an ankle sprain.
A sprained ankle and an ankle fracture are sometimes difficult to differentiate. If you have an inability to walk on the ankle, numbness in the toes, and/or excruciating sharp pain then this may indicate a fracture. If you do suspect a fracture then you should seek medical attention to determine whether or not an x-ray is needed.
Managing ankle sprains
First time lateral ligament sprains can be minor injuries that resolve quickly with minimal intervention. As outlined in our June 2018 blog POLICE protocol is advised for soft tissue injuries.
Some rest initially can be beneficial, immediately after an injury, but only for a very short period of time. Research shows that early mobilisation (loading) stresses tissues in the correct manner and stimulates healing, whereas rest can actually impair optimal recovery of soft tissue injuries. Too much rest and you’ll quickly develop joint stiffness and muscle weakness.
Some injuries may require some ‘protection’ such as using crutches for a few days. This will help to unload the injury enough to avoid further aggravation but still allow tissue stress to help with healing. But use of such protection should be minimised as you won’t be loading the area if it’s totally protected.
Use common sense when thinking about ‘optimal loading’. Don’t be afraid to move and use the injured area within your own limits of pain. A mild pain or discomfort is to be expected but anything more and you’re probably doing too much. Make sure that you keep progressing what you are doing, as this will help your injury heal better and longer term help prevent re-injury.
Ankle injury recurrence
Many people fail to recover because of persistent pain, recurrent injury, and instability with a recurrence rate of 70% in first time ankle sprains. These symptoms, which are characteristic of chronic ankle instability, result in long term constraints to levels of physical activity. Despite this, many people regard ankle sprains as being innocuous with fewer than half seeking formal treatment.
Poor rehabilitation after an initial sprain increases the chances of this injury recurrence.
How can physiotherapy help?
Using the knowledge of a physiotherapist can guide you on the stages of healing and what you should and shouldn’t be doing to ‘load’ your healing tissues.
While the sprained ligaments most commonly heal within 6 to 12 weeks, it is actually the functional restrictions that are important in the long-term for a sprained ankle. Residual stiffness, weakness, or instability can all negatively influence the final outcome you will have.
You can see that with the many factors involved, even simple ankle sprains can have an ongoing functional impact. Physiotherapy will accurately diagnose the specific tissue that is damaged in your ankle, identify any functional deficits that have occurred due to the injury, and guide you towards the best outcome for your ankle once it has healed.