The most common injury I see working with athletes is the lateral ankle sprain, or a sprain of the Anterior Talofibular Ligament. This injury can put someone out anywhere from 1 day to over a month depending on severity. Unfortunately, ankle sprains are often consider “minor” injuries and aren’t rehabilitated adequately, or even at all. Without correctly identifying the cause of the sprain (weak hips, poor proprioception, etc) and addressing it, we increase our risk of re-injury significantly. This can lead to what is known as Chronic Ankle instability, or CAI. CAI can cause negative long-term consequences, including chronic pain and feeling of giving out, that dramatically decrease our quality of life.

So you rolled your ankle, now what?

With my athletes, I always encourage them to come see me as soon as possible. The sooner we evaluate, the sooner we can treat and get them back on the field! My first step is always ruling out a more serious injury and determining whether a referral to a sports medicine physician is necessary. Once we have determined the nature and severity of the injury from a thorough evaluation, we immediately start the treatment process. What all does that entail? The first step is to control swelling and decrease pain. You may have heard the term RICE before (rest, ice, compression, elevation). Often times we take the rest portion too literally. Too much rest can lead to a decrease in strength and flexibility, and can hinder recovery. That’s why with lateral ankle sprains, I like to use the POLICE principle instead: 

  • P – Protect. This is the modified “Rest” phase. Whether it’s with crutches, a boot, or just a brace, we must protect the injured area from further damage.
  • Oand L– Optimal Loading. As soon as possible, gentle range of motion exercises should be started. As pain decreases, range of motion should increase!
  • I – Ice. Helps reduce pain. Be sure to protect the top layer of skin by putting a towel between the ice and your skin.
  • C– Compression. Controls swelling.
  • E– Elevate. Also controls swelling. Used in combination with compression can greatly reduce inflammation.

So, what?

 Okay so you might be thinking, “But I haven’t had an ankle sprain before…why does this matter to me?” Prevention is the key to a healthy and pain-free life, not just with ankle sprains but with most injuries and illnesses! Much of the strengthening and stretching that we do at Repke Fitness can help PREVENT future injury. For example, those side-steps with the band around your ankle that you love to hate? That exercise helps activate and strengthen your gluteus medius – a key muscle in preventing ankle injuries.

Treatment of Lateral Ankle Sprains

Treatment and prevention of lateral ankle sprains are very similar. First and foremost, we must make sure we have full range of motion (ROM) of the ankle, knee, and hip joints. Without full ROM on both sides of the body, another joint will have increased stress from trying to compensate for that deficit. This will increase the probability of injury at multiple points in the lower extremity. To increase ROM, we use stretches and mobility exercises like calf stretches, hamstring stretches and foam rolling.

Once we have full ROM, we need to increase our proprioception, or our awareness of our body’s position in space. To do this, we first focus on balance (strength strengthening and plyometrics come last). Exercises such as single-leg balance, tandem walking, and wobble board balance, help our brain understand where our ankle is in relation to the rest of our body.

The last phase of rehab is strengthening. Not only do we strengthen the muscles in the ankle joint where the injury occurred, we also need to strengthen the rest of the lower extremity. If you read these articles on the posterior and anterior chains,you’ll remember how everything in the body is connected (aka the kinetic chain). By addressing weakness in other areas of the body, we can help reduce re-injury and new injury in the future.

Conclusion

If not properly rehabilitated, a “simple” ankle sprain can result in Chronic Ankle Instability. This dysfunction is seen in up to 75% of those who sprained their ankle and can negatively impact an individual’s function later in life. The best way to treat ankle sprains is to PREVENT them! By implementing prevention strategies into your workout routine, you can greatly reduce your chance of ankle injuries.

When in doubt, always seek help from a medical professional.

Sources

  1. Shah S, Thomas AC, Noone JM, Blanchette CM, Wikstrom EA. Incidence and Cost of Ankle Sprains in United States Emergency Departments. Sports Health. 2016;8(6):547-552. doi:10.1177/1941738116659639.
  1. Fong D., et al. 2007. A systematic review on ankle injury and ankle sprain in sports. Sports Med 37(1):73–94.
  1. Terada M, Pietrosimone BG, Gribble PA. Therapeutic Interventions for Increasing Ankle Dorsiflexion After Ankle Sprain: A Systematic Review. Journal of Athletic Training. 2013;48(5):696-709. doi:10.4085/1062-6050-48.4.11.
  2. https://www.skimble.com/exercises/1005-single-leg-balance-with-leg-swings-how-to-do-exercise
  3. https://www.verywellhealth.com/the-police-principle-for-acute-sprains-and-strains-2696549
  4. https://www.homehealthcareshoppe.com/ankle-sprain-know-how
  5. https://blog.nasm.org/fitness/understanding-preventing-ankle-sprains-corrective-exercise/
  6. https://www.sandkingsports.com/importance-warming-sport-sports-injury-prevention/
  7. https://fitness.stackexchange.com/questions/34582/exercise-band-lateral-walk-muscles-used