By Lara McKenzie and Sarah Thorpe
Many of us have experienced an ankle sprain at some point in our lives. It’s no wonder, as they are one of the most common orthopedic injuries in both sports and leisure activities. Especially notorious for putting individuals at risk for ankle sprains are sports that involve sharp cutting or landing on one foot from a jump, such as basketball, volleyball, soccer, and football. The most common ankle sprain is a “lateral” ankle sprain—one in which the foot rolls in, injuring the structures on the outside of the ankle.
Current data suggest that 3 out of 100 people will incur an ankle sprain every year in the United States.1,2 If severe enough, ankle sprain injuries can cause long-term disability, and even relatively minor ankle sprains can increase your risk for a future sprain. In fact, it is estimated that up to 34 percent of people who experience acute ankle sprains will re-sprain their ankle.1 And, even though research indicates that rehabilitation improves proprioception, strength, and reaction time—all of which play crucial roles in ankle stability and prevention of re-injury3—more than half of those who suffer an acute ankle sprain will not seek treatment.4
Ankle anatomy 101
In order to understand ankle sprains, it is helpful to have some structural knowledge of the ankle joint itself.
Figure 15 shows a view of the outside (lateral) part of the ankle. Three ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) are responsible for supporting the ankle complex against inversion (inward rolling of the foot) forces. The one closest to the toes (the anterior talofibular) is most often injured in a lateral ankle sprain. We also have a very strong ligament on the inside (medial) aspect of the ankle that protects the ankle against eversion (outward rolling of the foot) injuries. Because this ligament is thick and strong, these injuries are quite rare and are not discussed in this article.
Movement at the ankle joint consists of pointing (plantar flexion), and flexing (dorsiflexion). The joint is least stable in plantar flexion—and this position is where sprains most often occur (for example, landing from a jump or stepping off of a curb).
What happens when we roll?
Ligaments attach bone to bone. When we roll the ankle beyond its anatomic range, the ligaments can be injured. Injury can range from mild (only some tearing of a few fibers) to severe (complete rupture). Many individuals report hearing a “pop” when they roll an ankle. This may be the result of the forces in your joint (similar to that experienced when you crack your knuckles), a ligament rupturing, or fracture.
With a mild sprain, the integrity of the ligament is pretty solid, and there will be minimal laxity (looseness) when tested. Severe sprains are associated with much greater joint laxity, which decreases the ankle joint’s protection from abnormal movements such as twisting, turning, and rolling of the foot. Regardless of the severity of the injury, neuromuscular control (communication circuits from the ankle to the spinal cord or brain) will be negatively impacted, which can have lasting implications if not addressed.
Whether an individual is able to continue an activity depends on the severity of the sprain; the more severe the sprain, the less the individual will be able to tolerate bearing weight on that side of the body. Swelling may take place immediately, or it may be delayed.
What to do if you’ve sprained your ankle
Minimize the swelling! Swelling inhibits surrounding muscles and decreases joint range of motion. Here’s how:
With a severe ankle sprain, the risk of fracture exists. Visit your doctor if:6
How can physical therapy help?
Unfortunately, once you suffer an ankle sprain you are at increased risk for another ankle sprain, even if your initial injury was minor.2 The single biggest risk factor for ankle sprain is a past history of ankle sprain.3 “Walking it off” is not good advice! Proper rehabilitation is important, and skipping this important step can lead to chronic problems.
A good physical therapist will:
There is hope for preventing an ankle sprain
If you would like to reduce your risk of experiencing an ankle sprain, read on! Research supports measures that you can take to minimize the likelihood of an ankle sprain. Notable treatments include:
If you are now thinking that you will buy a high-top shoe to reduce your risk of an ankle sprain, think again! No evidence exists that wearing high-top shoes will reduce your risk. In fact, the presence of air cells in some of these shoes has been found to increase the risk of an ankle injury.11
1 Van Rijn RM, van Os AG, et al. What is the clinical course of acute ankle sprains? A systematic literature review. The American J of Medicine 121: 324-341, 2008.
2 U.S. Census Bureau. Available at www.census.gov/. Last accessed: December 1, 2008.
3 McKeon PO, Ingersoll CD, et al. Balance training improves function and postural control in those with chronic ankle instability. Amer College of Sports Medicine. 1810-1819, 2008.
4 Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence based approach. Journal of Athletic Training 43(5):523-529, 2008.
5 Department of Health and Human Services, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases. Image source: www.niams.nih.gov/Health_Info/Sprains_Strains/default.asp.
6 Bachmann LM, Kolb E, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 326(7386): 417, 2003.
7 Stasinopoulos D. Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players.
Br J Sports Med April; 38(2): 182-185, 2004.
8 Mitchell A, Dyson R, et al. Biomechanics of ankle instability. Part 2: postural sway – reaction time relationship. Amer College of Sports Medicine. 1522-1528, 2008.
9 Olmstead LC et al. Prophylactic ankle taping and bracing: a numbers-needed-to-treat and cost-benefit analysis. Journal of Athletic Training 39(1):95-100, 2004.
10 Thacker SB et al. The prevention of ankle sprains in sports: a systematic review. The American J of Sports Medicine 27(6):753-760, 1999.
11 McKay GD et al. Ankle injuries in basketball: injury rate and risk factors. British Journal of Sports Medicine 35:103-108, 2001.
© Do not reproduce without permission from SSPT.
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