Tag Archives: ligament

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: 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. 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. 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). 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: Achieve strength and joint stabilityThanks 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. Reduction in the Risk of Chronic PainPast 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). Rehabilitate the Range of MotionA 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: 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: […]