Have you ever been out for a walk or a run and suddenly rolled your ankle? Or maybe it happened in the middle of playing your favorite sport? I’ve been there too, and according to research, we’re not the only ones. Today, we’ll look at what the evidence says about ankle sprains, break down what actually happens when you roll your ankle, and discuss why proper therapy is so critical to help prevent another sprain and avoid long-term damage.
What does the research say?
- ~2 million cases are reported annually in the United States.
- Acute ankle sprains are the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries.
- About 70% of people who have had an ankle sprain may develop residual physical disability.
- Multiple sprains can sometimes lead to chronic instability and even long-term joint damage.
- Only about 25% of people receive rehabilitation after a sprain.
- Exercise-based prevention programs can reduce the risk of ankle sprain by 28% and all ankle injuries by 47%.
Now that we’ve covered the research, let’s dive into what actually happens when you sprain your ankle.
What exactly happens when you sprain your ankle?
An ankle sprain happens when the ligaments around your ankle are stretched too far or torn due to sudden or awkward movements. Ligaments are tough bands of tissue that connect bones and provide stability to your joints, so when they’re damaged, your ankle becomes unstable.
Research shows that ankle sprains can also affect your proprioception, which is your body’s ability to sense where it is in space. For example, close your eyes and try to touch your nose with your hand. Proprioception is what helps you do that without needing to see where your nose is. When proprioception is affected in your ankle, it becomes harder to sense your foot’s position and movement, making you more likely to roll your ankle again.
Let’s break down the three main types of ankle sprains and how they happen:
- Inversion Sprain
This is the most common type of ankle sprain. It happens when your foot rolls inward, stretching or tearing the ligaments on the outside of your ankle. Inversion sprains are often caused by stepping on uneven surfaces, landing awkwardly from a jump, or sudden changes in direction during sports. - Eversion Sprain
An eversion sprain occurs when your foot rolls outward, stretching or tearing the ligaments on the inner side of the ankle. These sprains are less common because the inner ligaments are stronger but can occur when landing awkwardly or during sports. - Syndesmotic (High) Ankle Sprain
A syndesmotic sprain involves the ligaments above the ankle joint that hold together your lower leg bones. These sprains are usually caused by high-impact activities or twisting motions and can take longer to heal.
Each type of sprain varies in severity depending on how much damage occurred and whether other structures in the ankle were also affected. You can also get a combination of these sprains depending on the mechanism of injury. In more severe cases, the force of the injury can even cause fractures, cartilage and tendon damage.
Now that we’ve covered the types of sprains, how they happen, and the tissues involved, let’s explore the role physical therapy plays in their recovery.
The importance of physical therapy for preventing and treating ankle sprains
Ankle sprains might seem like a simple injury, but they can have lasting effects on your mobility and overall health. Studies show that nearly 70% of people who have one ankle sprain may develop residual physical disability, which can lead to something called chronic ankle instability. Chronic instability can cause ongoing pain, weakness, and a feeling like your ankle might “give way,” especially during physical activity. This can make everyday tasks harder and even increase the risk of more serious issues later on, like osteoarthritis.
This is where physical therapy comes in. Without proper therapy, the body doesn’t fully regain its mobility, strength, flexibility, and proprioception (the ability to sense where your body is in space). This makes the ankle more prone to sprains and injuries down the line.
So, what does effective physical therapy look like?
Restoring Range of Motion: A severe sprain can make your ankle stiff, limiting how much you can move it. Sometimes this can occur due to the way we move following a minor sprain or from being immobilized due to severe sprains. Therapy should include gentle stretches and techniques to restore movement. When your ankle has full mobility, it’s less likely to get hurt again. Having full mobility also helps your foot and ankle adapt to all types of surfaces and forces applied to it.
Strengthening the Muscles Around the Ankle: After a sprain, the muscles supporting your ankle become weaker. Without proper strength, they can’t fully stabilize the joint during movement or high impact activities like running. Physical therapy exercises targeting these muscles are important for both returning to activity and preventing future sprains.
Strengthening the Muscles in the Hip and Leg: Weakness in the hip and leg muscles can impact how well your ankle functions and stabilizes during movement. Without proper strength in these areas, your body may struggle to maintain balance and control, increasing the risk of injury. Exercises that target the hips and legs are important for improving overall stability, supporting the ankle, and preventing future sprains.
Improving Proprioception: A sprain can reduce your sense of balance and coordination. Proprioception exercises, like balance training on unstable surfaces and dynamic stability exercises, help retrain your brain and body to react to sudden changes in position. This improves stability and reduces the risk of awkward landings or missteps that could lead to another sprain.
Plyometric Training: Once the ankle has regained mobility, strength, and proprioception, plyometric exercises can be added. Plyometrics, like jump training, help the muscles and tendons around the ankle absorb and generate force quickly. This improves your ability to react to sudden directional changes, landings, and high-impact movements. You can read more about plyometrics from our previous blog.
Gradual Return to Activity: Returning to physical activity too quickly can increase your chances of reinjury. A gradual return to sport plan helps make sure your ankle is ready for the stress of regular movement, running, or playing sports. This process can take anywhere from weeks to months, depending on the severity of the sprain, but it’s important to give your ankle the time it needs to fully recover.
When done right and consistently, these therapy techniques can significantly reduce the chances of developing chronic ankle instability and other long-term problems. Research shows that people who go through a full therapy program after an ankle sprain are less likely to injure their ankle again.
Key takeaways
- Whether you’re recovering from a sprain or aiming to prevent one, physical therapy can help you recover and prepare your body to handle daily activities and sports, reducing the likelihood of future injuries.
- Programs that focus on strengthening the ankle, improving flexibility, and enhancing proprioception have proven effective in reducing sprain rates in athletes.
References:
Chen, Eric T. MD; McInnis, Kelly C. DO; Borg-Stein, Joanne MD. Ankle Sprains: Evaluation, Rehabilitation, and Prevention. Current Sports Medicine Reports 18(6):p 217-223, June 2019. | DOI: 10.1249/JSR.0000000000000603
Gribble PA, Bleakley CM, Caulfield BM, et al2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprainsBritish Journal of Sports Medicine 2016;50:1493-1495.
Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019 Jun;54(6):603-610. doi: 10.4085/1062-6050-447-17. Epub 2019 May 28. PMID: 31135209; PMCID: PMC6602402.
Ismail, Manal & Ibrahim Salem, Mohamed & Youssef, Enas & Shorbagy, Khaled. (2010). Plyometric Training Versus Resistive Exercises After Acute Lateral Ankle Sprain. Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 31. 523-30. 10.3113/FAI.2010.0523.
Kobayashi T, Tanaka M, Shida M. Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports Health. 2016 Mar-Apr;8(2):190-3. doi: 10.1177/1941738115623775. PMID: 26711693; PMCID: PMC4789932.
Thomas W. Kaminski, Alan R. Needle, and Eamonn Delahunt (2019) Prevention of Lateral Ankle Sprains. Journal of Athletic Training: June 2019, Vol. 54, No. 6, pp. 650-661.
