Have you recently experienced a high ankle sprain and are struggling with the recovery process? High ankle sprains can be particularly challenging to heal and require specialised care to ensure optimal rehabilitation.
High ankle sprains, also known as syndesmotic sprains, involve damage to the ligaments connecting the two shin bones (tibia and fibula) above the ankle joint. These injuries are common among athletes and can significantly impact mobility and performance if not treated effectively.
While conventional treatments like rest, ice, compression, and elevation are essential initial steps, physiotherapy plays a crucial role in the comprehensive management of high ankle sprains.
Physiotherapists are trained to assess, diagnose, and develop individualised treatment plans to promote healing, restore strength, and improve range of motion in the affected joint.
What is a high ankle sprain?
High ankle sprains involve a ligamentous injury slightly above the ankle joint. There are two long bones, tibia and fibula, that together form a stable surface connection for which the ankle can move. The stability of this joint is crucial for the function of the ankle and its ability to withstand weight-bearing activities.
This injury can appear similar to the more common lateral ankle sprain. However, it is more of an external rotation movement of the foot when it is planted, which commonly leads to a high ankle sprain.
With enough force, these injuries can also cause fractures or dislocations. It is important to distinguish a high ankle sprain from a lateral ankle sprain since the appropriate treatment will be different.
Delayed treatment can cause complications in the future if not addressed and managed effectively.
Common symptoms of a high ankle sprain
Symptoms generally include pain and swelling in front of the ankle, a sensation of instability, difficulty with or being unable to walk, or being unable to perform a single-leg heel raise.
Depending on the severity of the injury, it may either need conservative treatment or surgery with follow-up rehabilitation. One of the critical factors will be whether the distal tibiofibular joint is stable or unstable, which can be confirmed with imaging investigations.
It is crucial to promptly confirm an accurate diagnosis to develop an appropriate recovery plan.
Physiotherapy treatment for high ankle sprains
A typical physiotherapy rehabilitation program for a high ankle sprain will typically follow a phased approach:
A) Phase 1: Protection and pain relief (Weeks 1-2)
The main goals of this phase are to reduce pain and inflammation and protect the ligaments from further injury. Your physiotherapist will likely use modalities such as ice, ultrasound, and electrical stimulation to help reduce pain and swelling.
- Protective immobilisation: In some cases, a walking boot or splint might be needed for short-term immobilisation to prevent further strain on the ligaments.
- Gentle movement exercises: Exercises like ankle pumps can promote blood circulation and help reduce swelling while maintaining some range of motion.
B) Phase 2: Regaining range of motion (Weeks 1-3)
- Manual therapy: Techniques like massage and mobilisation can help improve flexibility and reduce stiffness in the ankle joint.
- Range of motion exercises: Gradually increasing range of motion exercises will target the plantar flexion (pointing your toes down) and dorsiflexion (pointing your toes up) of your ankle.
- Progressive exercises: As pain subsides, your physiotherapist will gradually increase the intensity and complexity of your exercises. This might include exercises like calf raises, ankle circles, and balance training.
C) Phase 3: Strengthening and proprioception (Weeks 3-6)
- Functional exercises: Exercises that mimic the demands of your daily activities or sport will be incorporated to improve proprioception (your body's awareness of joint position) and stability.
- Strengthening exercises: Strengthening exercises for the calf muscles, peroneals (muscles on the outer side of your ankle), and other ankle stabilisers are crucial for regaining stability and preventing future sprains. These exercises may initially involve therabands or bodyweight exercises and progress to weights and more challenging exercises as you get stronger.
- Proprioception exercises: These exercises help improve your body's awareness of your ankle's position in space, which is essential for balance and stability. Balance exercises, wobble board exercises, and jumping exercises can be incorporated into this phase.
D) Phase 4: Return to Activity (Weeks 6-8+)
Gradually progress towards returning to your normal activities. Your physiotherapist will design a program specific to your sport or activity to help you regain strength, flexibility, and agility.
This phase will include a return to plyometric exercises, cutting, jogging, and activity-specific re-integration. Plyometric training is frequently the missing connection between strength training and an athlete's return to sport.
Remember, physiotherapy is a collaborative effort between you and your physiotherapist. It's crucial to adhere to the recommended exercises and attend regular physiotherapy sessions to ensure optimal recovery.
Final thoughts
Physiotherapy for high ankle sprains is a crucial step in the recovery process.
By following a tailored treatment plan and working closely with a physiotherapist, you can speed up your healing time, regain strength and mobility, and prevent future injuries.
Remember, your health is worth investing in, so don't hesitate to seek professional help when dealing with a high ankle sprain. Here's to a speedy and successful recovery!
