• Patrick Everett, DPT


A high ankle sprain occurs when the connective tissue above and around the ankle, known as ligaments (see image), get damaged or over-stretched. This injury is more serious than other ankle sprains because these specific ligaments hold the two lower bones of the shin together. They provide stability and absorb large amounts of force during dynamic activities such as walking, running, jumping, or cutting.

Ankle sprains are a common occurrence among athletes in all sports. Whether it is going up to catch a football, heading a soccer ball or dunking a basketball, there is always a risk of landing incorrectly and injuring the ankle. The most common ankle sprain is an inversion ankle sprain, which can take 2 days to 2 weeks to heal depending on the severity of the injury. Unfortunately, the High Ankle Sprain is a more serious ankle issue.

What Causes High Ankle Sprains?

The most common high ankle ligament that is injured is the Interosseous Ligament, which spreads like a web between the two bones of your shin that runs from the top of the ankle to the bottom of the knee.

This ligament is typically injured when there is a large compression force on the ankle from impact, such as jamming one’s ankle into the ground when landing. You combine this with a rotational stress, in which the foot is turned outside in respect to the leg, and you have a recipe for a high ankle sprain.. For example in basketball, this typically occurs when two players are contesting for a rebound and one player collides into the other’s knee while he is landing. The actual mechanism of injury occurs when the two shin bones are pushed apart causing a overstretch or tear of the interosseous ligament if enough force is applied. The more typical inversion ankle sprain does not usually involve the interosseous ligament.

What are the Symptoms of a High Ankle Sprain?

Although high ankle sprains are slightly less common they are very easy to diagnose. Swelling and bruising typically occur within 24 hours on the inside, outside and higher portion of the ankle. it is important to ice immediately, rest, elevate and compress. During this time, it will be difficult to walk due to pain throughout the ankle. However, once the inflammation has reduced there are a few special tests to rule in a high ankle sprain and rule out any fractures. These test, one example being the squeeze test shown below, are typically performed by a team doctor, physical therapist or athletic trainer to help determine the need for an X-ray.

High Ankle Sprain Recovery Timeline

Ligaments have a much longer recovery time, lasting anywhere from 4 to 8 weeks. The recovery time is dependent upon the grade of the ligament sprain: grade 1 is a micro tear, grade 2 is more than 50% torn, or grade 3 is a complete tear. Other factors to consider that can slow recovery are progressing amount of weight bearing too quickly, adherence to a strengthening program, and one’s healing genetics. Fortunately, a grade 1 or grade 2 sprain often times does not require surgical intervention, and responds very well to treatment provided by physical therapy.

High Ankle Sprain Rehabilitation

Within the first 24-48 hours RICE (rest, Ice, compress, elevate) is crucial to the recovery process. As swelling decreases, a slow progression of pain free passive and active range of motion of the ankle occurs with light theraband resistance activity. While transitioning back to normal activity, the athlete may need to wear a boot in order to stabilize the ankle and limit the amount of weight the joint absorbs. Throughout the rehabilitation process, the physical therapist will progressively increase the amount of load the ankle can handle until the athlete is back to full weight bearing.

The first goal is returning the ankle back to its previous range of motion in all directions. In my experience as a ProSport / STACK Physical Therapist, pain is the largest limitation in an athlete’s recovery. I have found that the ZAMST A2-DX brace helps support the interosseous ligament reducing pain significantly without completely limiting range of motion.

Once basic strength is achieved and weight bearing is pain free, dynamic strength control and single leg balance exercises are incorporated into exercise program. In the final stages of the athlete’s rehabilitation, a progression through agility and plyometrics should be tested and built before returning to sport.

High Ankle Sprain Taping Technique

See attached Video

High Ankle Sprain Prevention

Of course the best rehabilitation for any injury is prevention. Although it is impossible to eliminate the random occurrence of every injury, there are some steps you can take to reduce the chances:

  1. Dynamic single leg balance - Various activities while standing on one leg. The most simple exercise would be standing on one leg without any other elements. The progression occurs by changing the surface the athlete is standing on to something less stable such as an airex pad. Once the athlete demonstrates proper stability, distracting components are added, such as throwing a basketball or upper body rotations.

  2. Proprioceptive awareness - Moving the foot in specific direction with eyes open then progressing to eyes closed. A example of this would be spelling out the alphabet with the foot and eventually progress to single leg balance with eyes closed.

  3. Lower extremity strength training - Traditional exercises that would progress from theraband resistance to weighted squats, lunges, calf raises etc..

A well planned offseason performance program is a great way to maximize movement mechanics, while minimizing the risk of injury and improving the longevity of an athlete’s career.

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