Ankle sprains are a common injury which occur when the ligaments in the ankle joint are stretched and/or torn. This injury occurs when the ankle goes beyond its normal range of motion. It results in pain, swelling, instability and impaired strength. If these symptoms persist for longer than 12 months this is known as chronic ankle instability, which occurs in 10-30% of individuals. The most common type is lateral ankle sprain which makes up 85% of all ankle sprains. Acute medial ankle sprains and syndesmotic/high ankle sprains are less common. Ankle sprains are more common in athletes, women and children. These injuries have a high recurrence rate of 70%.
There are several ligaments which contribute to the ankle joint’s stability which are distributed in the lateral, medial and syndesmotic regions. Lateral ankle sprains comprise approximately 85% of ankle sprains. This type of injury usually occurs when the ankle rolls inwards (inversion) beyond normal range and stretches the ligaments on the outside of the ankle. The remaining 15% involve medial and syndesmotic ankle sprains. A medial ankle sprain involves the ankle rolling outwards (eversion) stretching the ligaments on the inside of the ankle. A syndesmotic ankle sprain is an injury to one or more of the ligaments binding the distal tibia and fibula.
The severity of ankle sprain is classified into three categories. Grade 1 is a mild injury, which occurs when the ligaments are stretched without tearing. It is associated with minimal swelling and tenderness and little impact to function. Grade 2 is a partial tear of the ligament and is associated with moderate pain, swelling and tenderness along with decreased range of motion and ankle instability. Grade 3 is a complete rupture of the ligament and is associated with significant tenderness, swelling, loss of function and instability.
There are several factors which are considered a potential risk for ankle sprains. Some of these risk factors can be modified and identifying them can help in preventing this injury. Examples of these include muscle weakness, decreased range of motion, balance and proprioception. All of which can be addressed with a rehabilitation program. In addition, research has shown that exercise rehabilitation can help to reduce the risk of recurrent ankle sprain. It is important to have a structured rehabilitation program to enhance recovery and prevent injury recurrence. Being assessed by a physiotherapist to determine injury severity, ensure you are on a programme specific to your needs and reduce the risk of recurrence or developing chronic ankle instability is vital.
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References:
Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):603-10.
Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007 Jan;37(1):73-94.
Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014 Jan;44(1):123-40.
Rhon DI, Fraser JJ, Sorensen J, Greenlee TA, Jain T, Cook CE. Delayed Rehabilitation Is Associated With Recurrence and Higher Medical Care Use After Ankle Sprain Injuries in the United States Military Health System. JOSPT. 2021 Dec;51(12):619-27.
Delahunt E, Remus A. Risk factors for lateral ankle sprains and chronic ankle instability. Journal of athletic training. 2019 Jun;54(6):611-6.
Doherty C, Bleakley C, Hertel J, Caulfield B, Ryan J, Delahunt E. Recovery From a First-Time Lateral Ankle Sprain and the Predictors of Chronic Ankle Instability A Prospective Cohort Analysis. The American journal of sports medicine. 2016 Apr 1;44(4):995-1003
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