Ankle sprains are one of the most common lower limb injuries in sport, in particular "lateral" ankle sprains which involve the outside ligaments of your ankle.
Many people underestimate ankle sprains and only 55% of people who have sustained an ankle injury seek medial/physio treatment.
From a clinical point of view, the issue is that with ankle sprains there is a very high reoccurrence rate and around 20% of the general population and 30-50% of the athletic population will go on to develop "chronic instability" which results in long term symptoms of pain, swelling and instability if it is not diagnosed and treated correctly. It is believed that contributing factors to the development of chronic ankle instability are:
1) Very few will seek medical or physio attention for primary ankle sprains and
2) Most people return to sport too early; when their pain has resolved but other factors have not been rehabbed.
The good news with ankle sprains are that there are 3 simple things that you can do to reduce the risk of a primary or first time ankle sprain developing into chronic instability and these include.
1) Correct diagnosis and rehabilitation program: It is important that the ankle sprain is diagnosed and graded, your physiotherapist will be able to assess and determine whether it is ligamentous, tendon or boney involvement (sometimes more than one structure is involved). This will determine your rehabilitation and return to sport program to ensure you are not returning to impact too early. Furthermore, it will ensure a progressively loaded program to ensure structures have adequate time and load to heal and strengthening properly.
2) Exercise Therapy: Exercise therapy when performed in high doses (>900mins) significantly reduced the chances of recurrent ankle sprains by 42%. Exercise therapy also significantly improved function following a first time ankle sprain.
- 5x30mins per week = 150mins per week
- 150mins per week x 6 weeks = 900mins
3) Bracing/Taping: Reduces the risk of recurrent lateral ankle sprains by 62% in sport. It is currently recommended that a brace be worn on the injured ankle, or that it is taped for every game or training session for at least 6 months following the initial ankle sprain.
Take home messages:
1) Ankle sprains are not "just an ankle sprain", they need to be respected and treated accordingly.
2) Just because you no longer have pain does not mean that you're ready to return to sport. The subtle losses of strength, ROM, proprioception and balance do not magically re-appear once your pain has gone.
3) Make sure you see a physiotherapist and complete your recommenced rehab plan; 6 weeks of strength, balance, stretching, plyometrics, agility and a specific return to sport plan should be considered a non-negotiable part of the rehab plan.
4) Ensure that you brace or tape your ankle for training and games (dependant on sport) for at least 6 months following your sprain.
5) Like every injury, the decision to return to sport following a ankle sprain should be based on performance criteria such as strength, balance and hop tests rather than a set timeframe or the reduction/absence of pain alone.
