Ankle Sprain: Why you should care about it.

Ankle sprains are among the most common injuries, especially for athletes, active individuals, and even those who simply trip or misstep during daily activities. Despite being a frequent injury, the importance of properly recovering from an ankle sprain is often underestimated. Proper rehabilitation is crucial not only for returning to normal activities but also for preventing long-term complications like chronic instability, arthritis, or re-injury. In this blog, we’ll take a closer look at ankle sprains, their impact on the ligaments involved, and why recovery is so vital for the health of your ankle and the joints above it.

What is an Ankle Sprain?

An ankle sprain is an injury that occurs to the ankle ligament, which may stretch or be torn. Most commonly, this happens on the lateral portion of the ankle, as the plantar of the feet turn internally. The role of ligaments is to connect bones to each other and provide stability to the joint. In the acute phase of injury, you may experience swelling, pain, bruising, and sometimes instability in the joint. Mechanism of action includes sudden twisting, rolling, or turning motions, like sports or walking on uneven surfaces.

Not all ankle sprains are the same, indeed, we have a classification system for it, which is based on their severity:

• Grade I (Mild): A slight stretching or microscopic tearing of the ligament fibres, typically causing minimal swelling and pain.

• Grade II (Moderate): Partial tearing of the ligament, with noticeable swelling, bruising, and limited mobility.

• Grade III (Severe): Complete rupture of the ligament, leading to significant swelling, instability, and difficulty bearing weight.

Which Ligaments Are Most Affected?

The ankle joint consists of several ligaments, but sprains most commonly affect the lateral (outer) ligaments. These include:

• The anterior talofibular ligament (ATFL) is the most commonly sprained ligament on the front of the ankle.

• Calcaneofibular ligament (CFL): A ligament that connects the fibula to the heel bone.

• Posterior talofibular ligament (PTFL): Less frequently injured, but it can be involved in more severe sprains.

Studies show that the ATFL is the most commonly injured ligament, with up to 85% of all lateral ankle sprains involving this ligament (Kerkhoffs et al., 2012). The CFL is also frequently injured, but less commonly than the ATFL.

As mentioned above, most often an ankle sprain happens on the lateral portion of the ankle, but in rare cases, the deltoid ligament on the ankle’s medial (inner) side can be sprained, particularly during more forceful or traumatic incidents.

Why more laterally than medially?

Biomechanically, our ankle finds it easier to turn inwards than outwards. Therefore, it is easier to exceed in ankle inversion (the feet’ plantar face the medial line of the body) than the other way around. This is due to the disposition of the bond in the ankle and feet.

The Risks of Not Fully Recovering from an Ankle Sprain

Many people recover from an ankle sprain and return to normal activities, but this doesn’t always mean the ankle is fully healed. Incomplete recovery can lead to several risks, including:

1. Chronic Instability: If the ligaments don’t heal properly, the ankle may feel unstable, making it prone to future sprains or injuries. This can create a cycle of repeated sprains, leading to longer-term joint instability.

2. Re-injury: Insufficient rehabilitation increases the risk of re-injury. Returning to physical activity too soon or without proper strength can cause the ligaments to overstretch or tear again.

3. Arthritis: Studies have shown that improper healing of the ankle joint can lead to post-traumatic osteoarthritis (PTOA). This occurs when the joint surfaces are not properly aligned during healing, leading to cartilage degradation over time. Research suggests that 5-20% of individuals who suffer from ankle sprains may develop PTOA later in life (Delco et al., 2017).

4. Muscle Weakness and Atrophy: After a sprain, the muscles around the ankle often weaken due to disuse and immobilisation. This weakness can extend to other areas of the body, increasing the risk of compensatory injuries (e.g., knee or hip strain) as you change how you move to protect the injured ankle.

The Benefits of Proper Recovery

As with any injury, the recovery process is dictated by your subjective presentation, which includes your clinical history, fitness level, and more.

Here are some of the key steps for a full recovery:

1. Achieve strength and joint stability
   Thanks to the therapist’s guidance and a mix of treatment and exercises focused on the muscles that cross the ankle joint, like the peroneal and calf muscles, you can regain ankle stability and strength to return to your daily activities. This process can take up to 12 weeks, and its success is based on a mix of your clinical history and effort placed in the recovery process.

2. Reduction in the Risk of Chronic Pain
   Past the acute phase of injury, the risk of developing chronic pain is a common problem for individuals who don’t rehabilitate properly after an ankle sprain. In fact, studies suggest that proper rehab can reduce the risk of long-term pain by improving joint function and reducing stiffness with research indicating that patients who complete a rehabilitation program are 60-70% less likely to experience chronic ankle pain compared to those who don’t (Gribble et al., 2016; Zamperetti et al., 2019).

3. Rehabilitate the Range of Motion
   A key goal of rehabilitation is to restore the full range of motion (ROM) to the injured joint. Restoring normal ROM is critical for preventing compensatory movements that can strain other joints along the joint chain, like the knee, hip, or lower back.

The Recovery Process: What to Expect

Proper recovery from an ankle sprain typically involves several stages:

1. Acute Phase (0-72 hours) – P.E.A.C.E:

• Protect: Safeguard the injured area from further harm and avoid excessive strain.
• Elevate: Raise the injured area to reduce swelling and improve blood flow.
• Avoid Anti-inflammatories: Refrain from using anti-inflammatory medications unless advised by a healthcare professional, as they can hinder the natural healing process in some cases.
• Compress: Apply compression (e.g., with bandages or sleeves) to reduce swelling and provide support.
• Educate: Understand the injury, recovery process, and the importance of following proper care protocols.

 

       2. Sub-Acute Phase (1-3 weeks) – L.O.V.E:

• L – Load: Gradually introduce movement and exercise to load the tissue and promote healing.
• O – Optimism: Maintaining a positive mindset can improve recovery outcomes.
• V – Vascularization: Encourage cardiovascular activity to improve blood flow to the injured area.
• E – Exercise: Engage in targeted exercises to restore strength, mobility, and function. 

         3. Rehabilitation Phase (4-8 weeks):
            This phase focuses on restoring strength, flexibility, and balance through more advanced exercises. Proprioception and functional training (e.g.,    jumping, lateral movements) are key to re-establishing full joint function.

         4. Return to Activity (8+ weeks):
         The final stage is gradual reintroduction to sports or higher-level activity, which ensures the ankle is fully stable and strong enough to handle these demands.

As expressed earlier, the time of recovery is subjective and can change based on your presentation, the time you spent rehabilitating and resting, level of fitness and other componentes. What is universal, and that affect everyone is the mukltifactorial balance of exercises, rest, food intake, stress level, which combine can change your body response to recovery.

How can Melbourne Massage and Treatment help the recovery of an Ankle Sprain?

At Melbourne Massage and Treatment in Fitzroy North, I can help you recover from an ankle sprain by providing hands-on treatment during the acute and subacute phases and following it up with exercises for the rehabilitation and return to activity phases.

The treatment modalities I would offer are Myotherapy, which would involve modalities like Deep tissue massage, Dry Needling, joint mobilisation and exercises. Regarding the exercises, I also offer Private Fitness Class, where I use my Clinical Myotherapy knowledge to implement a strategy of injury prevention and, where needed, injury recovery exercises.

For those interested in following a protocol of recovery, I would suggest looking into the Treatment Plan, which give you access to a discount of 10% on a bundle of 3 to 5 sessions.

Frequently Asked Questions about Ankle Sprain

1. What first steps should I take immediately after spraining my ankle?

Answer: The first 72 hours following an ankle sprain are crucial for managing swelling and pain. Follow the P.E.A.C.E. protocol:

• Protect the injury from further strain,

• Elevate the ankle to reduce swelling,

• Avoid anti-inflammatory medications unless advised by your healthcare provider,

• Compress the ankle with bandages or sleeves,

• Educate yourself on the injury and proper care to ensure effective recovery.

2. How long does it typically take to recover from an ankle sprain?

Answer: Recovery time varies depending on the severity of the sprain:

• Grade I (Mild) sprains usually take 1-2 weeks,

• Grade II (Moderate) sprains can take 3-6 weeks,

• Grade III (Severe) sprains may require several months for complete recovery.
  Full rehabilitation often lasts up to 12 weeks and may involve gradual reintroduction of activities and strengthening exercises.

3. Can I still exercise during the recovery process?

Answer: Yes, but with caution. In the Sub-Acute Phase (1-3 weeks), it’s important to gradually introduce controlled, low-impact activities. This could include gentle range-of-motion exercises, light walking, and vascularisation exercises to improve blood flow. However, high-impact exercises and heavy loads should be avoided until the ankle has regained sufficient strength and stability.

4. Why is it important to avoid anti-inflammatories after an ankle sprain?

Answer: While anti-inflammatory medications like ibuprofen can reduce pain and swelling, they may interfere with the body’s natural healing process. Inflammation is part of the healing response, and reducing it too early may delay tissue repair. Always consult a healthcare professional to determine whether anti-inflammatories are appropriate for your recovery.

5. How can Melbourne Massage and Treatment help with my ankle sprain recovery?

Answer: At Melbourne Massage and Treatment, we offer a variety of services to help accelerate your recovery, including Myotherapy techniques such as deep tissue massage, dry needling, and joint mobilisation. We also provide targeted exercises to improve strength and mobility and prevent future injuries. Our Private Fitness Classes are designed to guide you through rehabilitation exercises and injury prevention strategies, tailored to your specific needs. Additionally, we offer a Treatment Plan with a discount on bundled sessions for more comprehensive support during recovery.

References: