An ankle sprain is an overstretching or tearing of one or more ankle ligaments. Ankle injuries are the most frequent injuries in sports. Sprains to the outer side of the ankle make up 85% of all ankle sprains.
How do ankle sprains occur?
The ankle joint has many ligaments that provide stability by limiting the amount of side-to-side movement. Ankle sprains are usually caused by an excessive rolling of the foot onto its outer edge so that the sole of the foot is turned inwards. This causes the ligaments on the outer side to overstretch and tear.
Individuals with a history of previous ankle sprains are more likely to have future ankle sprains than individuals who have not had one before.
Treatment
Apply the R.I.C.E.D. procedure.
Rehabilitation
Always seek the advice of a medical professional for a rehabilitation programme specific to you and your injury. To minimise the risk of re-injury, ensure you are completely rehabilitated before returning to competition.
Range of motion
Pointing and flexing the foot, or tracing letters with the foot, are good ways of improving range of motion following an ankle sprain.
Cardiovascular fitness
Swimming is recommended early in ankle sprain rehabilitation. As healing progresses, pain-free cycling and walking can also be included.
Strength
Regaining strength in the injured ankle will help to stabilise the ankle joint. Return to play is usually considered safe when 90% of pre-injury strength or 90% of the opposite ankle's strength (assuming that ankle is injury free) is achieved. Strength can be measured by contracting against resistance provided by another person. Ask them to make a comparison between legs.
Balance
Balance exercises, such as standing on one leg, help to minimise the likelihood of future sprains. Balance exercises can be made more difficult by performing them:
- with your eyes closed
- on an uneven surface such as a gravel pathway
- on an unstable surface such as a mattress.
Psychological status
Gradually attempting more difficult agility tasks and setting realistic goals and timeframes may help rebuild sporting confidence.
Sport-specific rehabilitation
When general function has been restored, rehabilitation should focus on preparing the ankle for sport-specific activity, such as jumping, landing and cutting. Different elements can be combined, for example, run, step off the right foot, step off the left.
Intensity should be increased as progress allows. For example, start running at 1/2 speed then increase to 3/4 speed and finally full speed.
Reduce the risk of re-injury
Always seek the advice of a medical professional before returning to sport. Inadequate rehabilitation will increase the risk of re-injury. You can reduce re-injury by continuing stretching, balance and strengthening exercises as part of your normal training routine.
Taping and bracing
Bracing and taping or wearing high top shoes provides some protection against joint injuries. The support provided by taping is generally reduced after 20 minutes of play, so where possible use braces rather than tape. Ensure that the brace:
- fits correctly
- complies with the rules of the game
- is suitable for you and the sport.
In sports where cleated shoes or boots are worn (eg cricket, rugby and soccer) a change in footwear design may reduce the risk of re-injury.
Stay conditioned for the physical demands of the sport. If ankle sprains continue to occur, consult a medical professional for advice on other possible contributing factors.
Resources
For more information, see Ankle sprains (PDF 182K).
Last updated: 20 April 2009