Ankle sprains are the most prevalent musculoskeletal injury in people who participate in physical activity. However the potential long-term consequences are often underestimated. This article explains why some ankle sprains take a long time to heal, and how a Physiotherapist can help you recover faster.
An ankle sprain occurs when there is damage to the ligaments of the ankle. The most common ligament to be injured is the one on the outside of the ankle (known as a lateral ankle sprain). This typically occurs if you roll your ankle inwards or twist awkwardly, usually when landing from a jump or when changing direction quickly. The severity of an ankle sprain varies from a mild sprain (involving one ligament) to complete ligament ruptures, multiple ligament injuries and fractures of the bone.
Symptoms include pain, swelling, bruising and difficulty walking or weightbearing. Treatment usually involves a short period of rest, ice and compression, followed by exercises to improve the ankle’s movement and strength. Most people don’t seek medical intervention. They assume they’ll recover after a few days rest, and be back to normal activities within a couple of weeks.
Unfortunately there is a high chance you’ll sprain your ankle again (up to 80%), particularly if you participate in high-risk sports such as netball, basketball and soccer. There is also a 70% chance you could develop chronic problems after a lateral ankle sprain. It appears there could also be a potential relationship between ankle sprains and ankle osteoarthritis. 70-85% of people that undergo surgery for posttraumatic osteoarthritis report that they have had a lateral ankle sprain.
The reason why some people develop ongoing symptoms is unknown but it’s likely to be multifactorial. Interestingly the severity of the initial injury doesn’t seem to predict whether someone will experience long-term problems or not.
Some factors that might cause long-term problems are:
- Failure to seek medical care or opinion.
- Early return to sport before physiological healing of the ligament.
- Not regaining full movement of the ankle.
- Inadequate restoration of muscle functions around the ankle joint and lower limb.
Common symptoms of chronic ankle problems are persistent pain; feeling like the ankle is going to give way, reoccurring sprains and limitations in everyday activities or sport.
How can a Physiotherapist help?
A physiotherapist can assess for injury to other structures in the ankle and foot, and determine whether imaging or a period of immobilisation is required. They can also assess whether there’s any issues with the ankle’s movement and strength, as well as identify any problems with walking and balance.
Physiotherapists can give you advice on how best to manage the injury in its early stages. They will also be able to tell you how long the ankle will take to heal, and when you will be able to get back to sport. If your physiotherapist has identified other problems during the assessment, such as lack of strength in the ankle, they can give you advice on how to fix these as well.
Range of movement
A Physiotherapist can give you an exercise program that will help restore the normal movement in your ankle. They can also treat your ankle with manual therapy techniques that help improve the joint’s range of movement.
People with chronic ankle instability are often weak in the muscles around the hip. A Physiotherapist can give you exercises to help strengthen these muscles, as well as the muscles around your ankle.
Balance/postural control exercises
Immediately after an ankle sprain your ability to balance on one-leg decreases. Interestingly this also affects the uninjured leg as well. In most people this resolves within a few months. However in those with chronic symptoms balance can remain affected for some time. Physiotherapists can help stabilise the ankle and improve your balance through different strategies and exercises.
Foot control exercises
The ligaments that hold the bones in the middle and front of your foot together can also be injured when you sprain your ankle. This is because the mechanism of injury is similar. If these ligaments are injured a Physiotherapist can show you how to strengthen the muscles that stabilise your foot. The exercises they will give you are called postural foot control exercises.
Recommendations from a recent systematic review advised bracing for six months following an ankle sprain when you return to sport. Your physiotherapist can advise you on appropriate braces and taping techniques.
Return to sport
A Physiotherapist can individualise your exercises and make them specific to the sport or activity you want to return to. They can also assess the way you run, jump or land to see if you need to change the way you do these things. Changing your biomechanics might help prevent you spraining your ankle again. It could also help you recover fully from your injury.
If you have recently sprained your ankle, or you have an ankle injury that isn’t healing, I’d encourage you to book an appointment with one of our Physiotherapists at Physiotas. The sooner you get your ankle looked at, and start getting treatment for it, the quicker your injury will heal.
Physiotas has six clinics located throughout the North and North West of Tasmania. Any of our physiotherapists will be able to help you. You can find the phone numbers for each of the clinics under ‘Locations’ on our website. You can also book your appointment online if this is easy for you.
About the author:
Lia is a Director of Physiotas. She is an APA Sports Physiotherapist, Musculoskeletal Physiotherapist and an Associate Fellow at the Australian College of Physiotherapists Specialisation program. Lia is part of the medical network for the Tasmanian Institute of Sport.
Lia is the clinical leader at our Launceston Clinic. Lia has also worked with elite athletes across many sports, including the Australian Rowing Team, Canadian Women’s Rowing team, the Australian Para cycling team in the lead up to the Rio Olympics and she volunteered at the London Olympics.
Lia has a special interest in hip, ankle and knee injuries (especially patellofemoral and ligament injuries) and the management of injuries in cyclists, runners and rowers.