Definitely one of the more common injuries in sport is the lateral ankle sprain. A “lateral” sprain means that it is on the outside of the ankle. It is more common to injure the lateral ankle than the medial ankle, because the ankle joint tends to roll easier, inwards. This inward roll is then how the ligaments on the lateral side are damaged.
There are three ligaments on the outer ankle, however, the majority of ankle sprains (approx. 70%) result in isolated damage to only one of them – the anterior talofibular ligament, or ATFL. The ATFL connects the lateral malleolus to the talus, shown in the picture to the right.
In addition to the lateral ankle ligament sprain, there are other problems that may occur during an ankle injury. These include high-ankle sprain, cuboid syndrome, osteochondral lesion and medial ankle sprain. An x-ray to check for fracture is indicated if there is difficulty taking weight on the foot for more than 4 steps.
An ankle sprain can be graded into 3 different categories.
Grade 1 = no loss of function, no ligament laxity
Grade 2 = some loss of function, laxity of the ATFL ligament
Grade 3 = near-total loss of function, laxity of ATFL and other ligaments
The higher the grade, the longer it will take for a full recovery of the ankle.
Therapeutic exercises should begin early for the acute ankle injury and should include balance exercises to be done at home. One study shows that the rate of re-injury is significantly reduced at the 1-year mark when an exercise program is introduced within 1 week. Depending on the severity of the ankle sprain it may be necessary to immobilise the ankle with the use of a brace, or even with a moonboot.
Typical exercises for the ankle include –
- wobble-board exercises
- heel raises
- lateral movements including hops and jumps
- isometric resistance exercises (with use of a band)
- manual therapy
Your physiotherapist is skilled in advising you “when” is the right time to initiate your exercise program, what the limitations are in regards to exercise and sport, and what type of brace to use.
Returning to your sport could be anywhere from 1 week to 3 months, depending on the severity of your injury. It is recommended that before returning to sport, that you are able to complete a lateral hop test, and prove that your hop distance on the injured ankle, is equal to the distance on your uninjured side. The lateral hop test is three, sideways hops, from a stationary starting position. The distance of the three hops is then measured. This test is a measure that is taken towards the end of the rehab process when pain levels have significantly reduced.
For more advice on your ankle sprain and how to best manage it, see your physiotherapist to have your ankle injury assessed and a rehab plan prescribed.