An ankle sprain refers to tearing of the ligaments of the ankle. The most common ankle sprain occurs on the lateral or outside part of the ankle. This is an extremely common injury which affects many people during a wide variety of activities.
They range from mild to severe, depending upon how much damage there is to the ligaments. Without proper treatment and rehabilitation, a more severe sprain can weaken your ankle—making it more likely that you will injure it again. Repeated ankle sprains can lead to long-term problems, including chronic ankle pain, arthritis, and ongoing instability.
Your foot can twist unexpectedly during many different activities, such as:
- Walking or exercising on an uneven surface
- Falling down
- Participating in sports that require cutting actions or rolling and twisting of the foot—such as trail running, basketball, tennis, football, and soccer
- During sports activities, someone else may step on your foot while you are running, causing your foot to twist or roll to the side.
Symptoms and Diagnosis
A sprained ankle is painful. Other symptoms may include:
- Tenderness to touch
- Instability of the ankle—this may occur when there has been complete tearing of the ligament or a complete dislocation of the ankle joint.
- If there is severe tearing of the ligaments, you might also hear or feel a "pop" when the sprain occurs. Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation.
A health professional should be able to easily diagnose an ankle sprain but X-Rays, MRI scans and Ultrasound can also help.
When the diagnosis happens, you'll also find out what grade of injury it is. This basically describes the severity of the injury. Grades are split into three sections and are explained below;
Grade 1 Sprain (Mild)
- Slight stretching and microscopic tearing of the ligament fibers
- Mild tenderness and swelling around the ankle
Grade 2 Sprain (Moderate)
- Partial tearing of the ligament
- Moderate tenderness and swelling around the ankle
- If the doctor moves the ankle in certain ways, there is an abnormal looseness of the ankle joint
Grade 3 Sprain (Severe)
- Complete tear of the ligament
- Significant tenderness and swelling around the ankle
- If the doctor pulls or pushes on the ankle joint in certain movements, substantial instability occurs
A three-phase program guides treatment for all ankle sprains—from mild to severe:
Phase 1 includes resting, protecting the ankle and reducing the swelling.
Phase 2 includes restoring range of motion, strength and flexibility.
Phase 3 includes maintenance exercises and the gradual return to activities that do not require turning or twisting the ankle. This will be followed later by being able to do activities that require sharp, sudden turns (cutting activities)—such as tennis, basketball, or football.
This three-phase treatment program may take just 2 weeks to complete for minor sprains, or up to 6 to 12 weeks for more severe injuries.
The RICE protocol.
Follow the RICE protocol as soon as possible after your injury:
- Rest your ankle by not walking on it.
- Ice should be immediately applied to keep the swelling down. It can be used for 20 to 30 minutes, three or four times daily. Do not apply ice directly to your skin.
- Compression dressings, bandages or ace-wraps will immobilize and support your injured ankle.
- Elevate your ankle above the level of your heart as often as possible during the first 48 hours.
- Medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help control pain and swelling. Because they improve function by both reducing swelling and controlling pain, they are a better option for mild sprains than narcotic pain medicines.
Early Range of Motion.
To prevent stiffness, you can start performing light exercises that involve range-of-motion or controlled movements of your ankle without resistance.
The Alphabet - Use your toes to “write” the letters of the alphabet in the air. This exercise works the ankle in all ranges of motion and exercises the muscles that are affected by ankle sprains.
Once you can bear weight without increased pain or swelling, exercises to strengthen the muscles and tendons in the front and back of your leg and foot will be added to your treatment plan. Water exercises may be used if land-based strengthening exercises, such as toe-raising, are too painful. Exercises with resistance are added as tolerated.
Resisted plantar flexion - Loop a resistance band around the forefoot and hold onto the ends. Point the foot away slowly allowing it to return to a resting position. Aim for 10-20 reps and 3 sets with a short rest in between. Once this exercise feels easy, you can increase the strength of the resistance band or progress on to full calf raise exercises. This exercise can be repeated with a bent knee to target the soleus muscle lower down the calf area.
Resisted dorsiflexion - Using a rehabilitation band pull the foot and toes up against resistance and then down again. Aim for 10 to 20 repetitions and 3 sets with a short rest in between. This is an important strengthening exercise, however it is important not to over do this one. Remember you will still have to walk on the ankle after the strengthen session so do not take the ankle to fatigue. Over time this may also lead to pain in the front of the shin - less is probably more with this exercise.
Isometric eversion and inversion - Once you can do so pain free, try exercises involving eversion and inversion to help strengthen the muscles which help to control the 'rolling' action at the ankle. Isometric means there is no movement at the joint throughout the exercise. A partner or therapist can provide resistance with the hands, or you can use a wall or chair leg. For eversion the athlete should try turning the ankle out against resistance. For inversion, inwards against resistance. Hold for 5 seconds, rest for 3 seconds and repeat initially 3 times and gradually increase up to 10 times.
Calf raise - This exercise will strengthen the calf muscles which consist of the gastrocnemius and soleus muscles. Rise up and down on the toes in a smooth movement. You should be able to progress quite quickly with this one but aim for 3 sets of 10 and build up steadily, a few each day.
Once you find this quite easy, start performing the exercise on one leg only. This will feel a lot harder, so start with low reps again and gradually increase. You can also perform these on a step as shown in the video, allowing the heel to drop down past the level of the step.
Proprioception (balance) training.
Poor balance often leads to repeat sprains and ankle instability. A good example of a balance exercise is standing on the affected foot with the opposite foot raised and eyes closed. Balance boards are often used in this stage of rehabilitation.
Standing on one leg eyes open with arms out - Clear an area without obstacles and stand on one leg on a flat surface with bare feet and arms out to the side. Balance for as long as possible and record how long you balanced for without putting the other leg down, repeat 5 times for each leg.
Standing on one leg eyes open and arms by your side – Similar to the previous exercise but this time you're to keep your arms down by your side. If you feel you are losing balance, put the other foot down. Record how long you balanced for.
Standing on one leg eyes closed - If you feel you are losing balance, either open your eyes or put the other foot down. Record how long you balanced for.
Standing on an unstable surface (such as a folded towel or cushion) - Again, a similar exercise but this progression adds an uneven surface to make the exercise harder. Keep your eyes closed during the exercise. If you feel you are losing balance, either open your eyes or put the other foot down. Record how long you balanced for.
Hopping - Draw a line on the floor with tape and stand one side of the line on one foot. Hop from one side of the line to the other and back again. On landing, stay balancing on one leg for 2 seconds before hopping again. Repeat 20 times for each leg.
Figure 8 Hopping - Draw a cross on the floor with tape and stand in one corner and hop diagonally to opposite corner. Then hop sideways to the next corner. Then hop diagonally backwards to the opposite corner. Then hop sideways back to the starting position. Repeat 5 times for each leg.
Endurance and agility exercises.
Once you are pain-free, other exercises may be added, such as agility drills. Running in progressively smaller figures-of-8 is excellent for agility and calf and ankle strength. The goal is to increase strength and range of motion as balance improves over time.