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Sprained your ankle?
What causes a sprained ankle?

There are 5 risk factors that can cause the problem to persist

Ankle sprains are very common...so common that they are the #1 injury present at most accident and emergency departments in public and private hospitals.

In fact, most of us will have experienced an ankle sprain at some point in our lives unfortunately.

Most common type of ankle sprains affects the ligaments on the outer part of the ankle as they get over stretched when our ankle roll inwards. Of course, sometimes other tissues around the ankle can be injured at the same time too.

If you are fit, healthy, heal well and have no recurrent/previous history of ankle sprains, then your acute ankle sprain will typically heal within 6-8 weeks (that's about 1.5 to 2 months).

During this time, you will experience also

• pain in your ankle with movements and maybe with weightbearing
• feeling that your ankle is a "little" unstable

As you heal, the pain and instability feeling will improve.

In some cases, the pain and instability may last longer than 6-8 weeks from the original date of the ankle sprain, and there are multiple reasons for this. You will need an indepth assessment to determine the severity and if there are any other structures involved.

What factors can influence ankle sprain symptoms and how they can be addressed ?

Here we discuss a few of the factors that can influence symptoms and why it is important to address these things early on:

1. Multiple Ligaments – 

We need to have clarity on the the:

• number of ligaments that are damaged
• the severity of the damage
• the locations of the ligament sprain along the length of the ligament (not so important but good to know as well)
  

Not all ankle sprains are the same - depending on the location, severity and numbers of sprained ankle ligaments, they can have different outcomes, pain and impact on the patient.

We have to test the ankle joint and ligaments in isolation to determine the damage and diagnosis, and this in turn will allow us to understand the problem in its entirety, set realistic goals, determine physiotherapy treatment plans.

Patients need to be patient to follow ankle sprain physiotherapy restrictions especially in the early stage as the early stage is the highest risk of re-injury.

2. Biomechanics & Positioning –

We'd need to determine:

• The position your foot adopts both before you even injure your ankle
• the natural anatomy of your foot and also
  
• the position is chooses to adopt after the injury is important to how you may recover.

Ankle sprain research shows that people who weight bears on the outer part of their foot are more at risk of injuring their ankle ligaments by rolling their ankle outwards...

...this happens because your ankle is already closer to the limit of where the ligament gets stretched and so rolling outwards on the ankle can occur easier.

Also, once you've sprained your ankle once, it jumbles up the proprioceptive feedback system that your ankle has (it functions to inform you/your brain where your ankle is, sort of like a GPS system for your ankle), so post ankle sprain, your ankle GPS isn't as strong as before.

This increases the risk of re-spraining your ankle unfortunately...and is one of the core focus of our ankle physiotherapy treatment in our clinic (because we can treat ankle sprains easily, but we also need to ensure/decrease the ankle sprain rate that our patient gets for full recovery).

3. Strengthening –

Very common after an ankle sprain injury, patients are given a set of ankle exercises to do that may include strengthening the ankle muscles to better support around the ankle ligaments (to behave like a natural muscle brace that we might wear)

This is good news.

However,

1. often patients start to improve and then forget the exercises, or
   
2. patients are worried about how much to do or their physiotherapist in charge of them doesn’t progress enough and re-injury can occur.
   

It is important that strengthening happen right into the movements that the ankle is most at risk in.

Eg

1. If patient has had an ankle sprain before, and now has a jumbled up proprioception (awareness of where the ankle is in relation to the body), then proprioception needs to be a focus
2. If the patient has weak ankle muscles, then strengthening needs to be a focus
3. If the patient later develops ankle stiffness, then mobility and range of the ankle needs to be of a focus
4. etc
   

4. Stiffness –

Often after an ankle sprain injury, our injured ankle will naturally stiffen up

• due to the natural healing process (to protect the join)
• and also due to decrease mobilization/movement (due to pain/resting/protecting the joint)

These are normal in the short term but must be addressed as your ankle heals to allow you to fully use of the ankle and full recovery. We will have to address stiffness (as soon as it's medically and orthopedically stable) by:

• heat therapy followed by
• gentle active range of motion exercises
• passive range or motion stretches

Some patients think that after an injury, their ankle shouldn't be touched as it needs to rest for 2 months or that stiffness is good but that isn't true - our ankle needs to be mobilized as soon as it's medically clear to to prevent over-tightness/over-stiffness which is a real risk and has its own set of problems.

5. Non-Compliance To Physiotherapy  –

Research has looked at why some ankle sprains don’t get as good as they can be, and they found that one big risk factor that has been identified is non-compliance with the physiotherapy advice and exercises.

It might seem obvious but if you

• avoid normal movement
• don’t get rid of stiffness
• fail to return your strength to normal
  
• stop exercises early then you do risk your ankle sprain taking longer to recover