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So you were playing basketball and landed on the outside of your foot when coming down from a jump. Or you are a soccer player and “stepped wrong” during a game. Your ankle is swollen and you think it’s sprained. What exactly is going on?

Ankle sprains are common! Studies have shown that lateral ankle sprains account for up to 28% of sport related injuries!1 There are three main ligaments on the outside of the ankle that can be affected. As pictured, the first may be the posterior talofibular ligament (PTFL) that attaches from the back of the heel to the ankle over the boney protuberance that you can feel. Second is the calcaneofibular ligament (CFL) that attaches from the heel bone to the outside of the ankle. The third and most commonly injured is the anterior talofibular (ATFL) ligament which is put under tension when pointing the toe downward and in which is common when rolling an ankle. As with any injury, there are varying degrees of severity. Here are the different grades of sprains:

  • Grade 1: stretching causing small tears within the ligament; painful but minimal instability

  • Grade 2: larger but incomplete tearing; painful with notable ankle instability

  • Grade 3: complete tearing; no pain with significant instability

Healing of an involved ligament that isn’t completely torn can typically take up 6 weeks to 3 months.2 Even though the tissue may be healed around that 6-week mark, it can still have laxity causing predisposition to re-injury. This is why it is critical that once out of the acute painful stage, progressive strengthening and stability training occurs to allow return to sport.

So what do you do?

If you have significant swelling, pain, and feelings of instability, evidence shows using a lace-up brace can significantly help with swelling and increased tolerance to putting weight on the involved foot early on during recovery.3 Ice or “cryotherapy” has shown to significantly decrease pain with fresh injures; you can do this for 15-20 minutes at a time then let the ankle get back to room temperature before applying ice for another round. 4 And physical therapy of course! It’s best to see a physical therapist to see if there are additional structures that may have been injured. For a ligamentous injury studies have shown that manual therapy involving soft tissue massage, joint mobilization, stretching, and therapeutic exercise improve overall outcomes from an ankle sprain! 5, 6 Exercises can include active range of motion, calf and ankle muscle strengthening, balance, and sport specific activities to allow you to get back to what you love to do!

  1. Journal of Orthopaedic & Sports Physical Therapy, 2013 Volume:43 Issue:9 Pages:A1–A40 DOI: 10.2519/jospt.2013.0305.

  2. Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008;43(5):523–529. doi:10.4085/1062-6050-43.5.523.

  3. Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly KD, Struijs PA, van Dijk CN. Immobilisation for acute ankle sprain. A systematic review. Arch Orthop Trauma Surg. 2001; 121: 462– 471.

  4. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004; 32: 251– 261.

  5. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc. 2003; 103: 417– 421.

  6. Bleakley CM, O'Connor SR, Tully MA, et al. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010; 34: c1964.

Image source: https://anklepro.wordpress.com/ankle-sprain-101/

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