Ankle sprains, a prevalent injury that affects individuals in every age group and activity level, are among the most common injuries. These injuries occur when the ligaments surrounding the ankle joint are stretched or torn, usually due to sudden twisting or rolling motions. This blog will delve into the types of ankle sprains, their causes, symptoms, healing timelines, and how physical therapy can aid recovery and prevention.
Types of Ankle Sprains
Lateral Ankle Sprain (Inversion Sprain)
The most commonly injured structures in a lateral ankle sprain are the lateral ligaments, including the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). These ligaments stabilize the outer part of the ankle.
Lateral ankle sprains account for approximately 85% of all ankle sprains, making them the most frequent type of ankle injury.
Medial Ankle Sprain (Eversion Sprain)
This type of sprain involves the deltoid ligament complex (DLC), located on the ankle’s inner side and provides stability against eversion forces. The DLC is much more than the lateral ankle ligaments, making these sprains less common than lateral sprains, accounting for around 5-15% of ankle sprains.
High Ankle Sprain (Syndesmotic Sprain)
High ankle sprains involve the syndesmotic ligaments, which connect the tibia and fibula above the ankle joint. These ligaments stabilize the two bones during movement.
High ankle sprains are less frequent but are more common in sports such as basketball, representing up to 10% of all ankle sprains.
Causes of Ankle Sprains
Ankle sprains occur when the ligaments surrounding the joint are stretched or torn due to excessive force or awkward movements. The specific mechanism of injury varies depending on the type of sprain.
Lateral Ankle Sprain
Often described as the classic “rolled ankle,” this occurs when the foot twists inward, overstretching the lateral ligaments (e.g., anterior talofibular ligament). It typically happens during activities involving sudden direction changes, missteps on uneven surfaces, or landing awkwardly after a jump.
Medial Ankle Sprain (Eversion Sprain)
This occurs when the foot is planted and the ankle rolls outward. The stress placed on the deltoid ligament can result in tears or overextension. This type of injury often happens during sports involving sudden lateral movements or a fall where the foot remains fixed while the body twists.
High Ankle Sprain (Syndesmotic Sprain)
High ankle sprains occur when the foot is planted and a strong external rotation or dorsiflexion force separates the tibia and fibula at the syndesmotic ligaments. These injuries are common in sports like basketball or football, especially during intense pivoting or when landing from a jump with the foot turned out.
Symptoms of Ankle Sprains
Ankle sprains can present with varying symptoms depending on the type and severity of the injury.
Lateral Ankle Sprain
- Pain and swelling on the outer side of the ankle.
- Bruising and difficulty bearing weight.
- Instability during walking or standing.
Medial Ankle Sprain
- Pain and tenderness on the inner side of the ankle.
- Swelling and bruising around the medial aspect of the joint.
- Pain with walking
High Ankle Sprain
- Pain above the ankle joint, especially when twisting or bearing weight.
- Difficulty with dorsiflexion and walking.
- Pain with hopping
Ankle Sprain Healing Timelines: Different Stages & Recovery Duration
An ankle sprain’s healing timeline depends on the injury’s severity and any history of prior sprains. Sprains are typically categorized into three grades:
Grade 1 (Mild):
- Mild overstretching of the ligament with minimal pain, swelling, and slight tenderness.
- Healing Time: 1-3 weeks, with proper rest and rehabilitation.
Grade 2 (Moderate):
- Partial tearing of ligaments, moderate swelling, and difficulty bearing weight.
- Healing Time: 4-6 weeks, including physical therapy.
Grade 3 (Severe):
- Complete ligament tear, significant swelling, and instability.
- Healing Time: 3+ months, and in some cases, surgery may be required.
Additionally, high ankle sprains typically take longer to heal due to the involvement of syndesmotic ligaments. Recovery can range from 6 weeks to several months, depending on severity.
Evolving Physical Therapy Treatment for Ankle Sprains
In the past, the standard approach to managing ankle sprains was the RICE method:
- Rest: Avoid putting weight on the injured ankle.
- Ice: Apply cold packs to reduce swelling.
- Compression: Use bandages or wraps to limit swelling.
- Elevation: Keep the ankle elevated above heart level.
While RICE aimed to reduce pain and inflammation, it often led to prolonged periods of inactivity, which could delay recovery.
The Shift to P.O.L.I.C.E.
Modern rehabilitation strategies now emphasize the POLICE protocol, which encourages a more active recovery process:
- Protection: Avoid activities that could worsen the injury but allow safe movement.
- Optimal Loading: Gradually introduce movement and weight-bearing to stimulate healing.
- Ice: Used sparingly to manage pain, though excessive use may delay tissue repair.
- Compression: Helps reduce swelling and supports the joint.
- Elevation: Assists in controlling swelling in the initial phase.
Graded Exposure and Key Physical Therapy Techniques for Ankle Sprain Recovery
Physical therapists focus on graded exposure, a method that progressively reintroduces movement and weight-bearing based on pain levels. This approach ensures the ankle regains strength and mobility without overloading the injured tissues. For instance, if a certain movement causes mild discomfort, the therapist may advise reducing the intensity or frequency of that movement until the ankle can tolerate it without pain.
Key components of physical therapy for ankle sprains include:
- Range of Motion Exercises: Gentle movements to restore flexibility.
- Strength Training: Targeting the surrounding muscles for stability and support.
- Balance and Proprioception Drills: Enhancing neuromuscular control to prevent future sprains.
- Sport-Specific Drills: Preparing athletes for a safe return to their activities.
By adhering to these principles, physical therapy plays a pivotal role in accelerating recovery and reducing the likelihood of recurring injuries, providing reassurance and confidence in the healing process.
Take Control of Your Recovery: How Physical Therapy Can Help Heal and Prevent Ankle Sprains
Ankle sprains, though common, are often underestimated injuries that can significantly affect mobility and quality of life. Understanding the types, causes, symptoms, and recovery timelines is crucial for proper management. By gaining this knowledge, you can take control of your health and recovery. Don’t let an ankle sprain keep you on the sidelines. Physical therapy can speed up recovery, improve mobility, and prevent future injuries. Ready to take the first step toward healing? Find a physical therapy location near you and start your journey to stronger, healthier ankles.