Breaking The Ankle Sprain Cycle

Let’s talk ankle sprains. Chances are, you’ve had one. In fact, in sporting and general populations alike, they’re among the most common musculoskeletal injuries. Now, we’re interested to know: what was your rehab like? All too often, the generic advice for healing a sprain is to RICE (rest, ice, compress, elevate) until inflammation subsides. Then, get straight back to it. Simple, right? Well, current evidence suggests one of the primary risk factors for an ankle sprain is a prior sprain. This means that if you’ve sprained your ankle once before, you’re more susceptible to a future sprain than someone who hasn’t.

To appreciate why this is the case, it’s important to understand some ankle anatomy fundamentals: the ankle joint, otherwise known as the talocrural joint, is formed by the articulation of the tibia and fibula (your shin bones) with the talus (one of the bones of your foot). These bones are supported and passively stabilized by strong, fibrous bands of tissue known as ligaments. Ligaments span from bone to bone, and prevent excessive motion of the joint. They also relay information to the brain about where the body is in space, which is important for balance and proprioception. When an ankle sprain occurs, the foot is moved or loaded in such a way that these ligaments are stretched and/or torn. A grading system is used to classify the severity of the sprain, ranging from Grade 1 (minimal ligament stretch, no tear) to Grade 3 (full ligament rupture).

Depending on the grade of the sprain, healing times can range from 1 week to several months. During this time, affected ligaments are not able to provide the same degree of stability to the joint as they previously could. Even when fully healed, ligaments often don’t have the same degree of tensile strength they did pre-strain: they’re micro-structure remains slightly altered, and they’re usually a little more ‘lax’. Additionally, when ankle ligaments are damaged, there is a reduced ability to provide feedback to the central nervous system about the position of the joint, resulting in a loss of balance/proprioception. It is these changes that accompany an ankle sprain that place you at increased risk of recurrence.

So, how do you break the cycle? It’s all in the rehab.

Initially, treatment should comprise POLICE: protection, optimal loading, ice, compression, elevation. This will help reduce swelling, maintain joint range of motion, and stimulate healing.

Then, to compensate for the loss of passive stability afforded by ankle ligaments, it’s important to develop active stability. This comes from muscles. So, once out of the acute phase, it’s time to gradually progress strength-based exercises. At this stage, rehab should also start to incorporate more balance and proprioception drills, including single leg stability work.

As rehab continues, the ankle should be exposed to higher impact loads with hopping/plyometric exercises, as well as different directions of force with change-of-direction drills. If you’re looking to return to a certain sport or activity, this is prime time for sport-specific work.

So, there you have it: the rehab you undergo following an ankle sprain should develop strength through range, hone balance and proprioception, and improve single leg control. Overall, this creates dynamic stability, which gives you the best change of staying injury-free.