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Get Back in the Game: Effective Lateral Ankle Sprain Rehabilitation for Athletes

Updated: Feb 5

What is a lateral ankle sprain? 

A lateral ankle sprain is a common injury that occurs when the ligaments on the outer side of the ankle joint are stretched or torn. These ligaments play a crucial role in maintaining stability and supporting the ankle's range of motion.

There are three main ligaments on the outside of the ankle, the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). These ligaments connect the bones of the foot to the leg, and are essential for providing stability during movements. The ligaments most commonly injured are the ATFL and CFL.

How do I know if I have a lateral ankle sprain? 

Lateral ankle sprains typically occur when the foot rolls inward, causing the ligaments on the outer side of the ankle to stretch beyond their normal range. Walking, running or jumping on uneven surfaces, sudden change of direction, or even a slip or fall are common modalities for ankle sprains. 

Grades of Lateral Ankle Sprains:

Lateral ankle sprains are classified into three grades, each indicating the extent of ligament damage:

Grade 1: Minor stretching or tearing of the ligament with mild tenderness, swelling and stiffness. Generally, individuals with a Grade 1 sprain can still bear weight on the affected ankle.

Grade 2: Moderate stretching and tearing of the ligament with moderate pain, swelling and bruising. Those with a Grade 2 sprain may experience difficulty walking and often require some form of support, like crutches.

Grade 3: Complete tear of the affected ligament with severe swelling and bruising.  Individuals with a Grade 3 sprain may find it challenging to bear any weight on the injured ankle and often require more extensive medical attention.

What are my management options?

Lateral ankle sprains can occur due to different reasons between people, so it is important to get your ankle assessed to be confident you’re addressing the factors that are most specific to you. Some example management options can include: 

R.I.C.E Protocol: 

  1. Rest: Give your ankle time to heal by avoiding activities that put stress on the injured ligaments.

  2. Ice: Apply ice to the affected area for 15-20 minutes every 2-3 hours during the initial 48 hours to reduce swelling and pain.

  3. Compression: Use a compression bandage to help control swelling. Make sure it's snug but not too tight.

  4. Elevation: Elevate your ankle above the level of your heart when possible to minimize swelling. 

Bracing: Depending on the severity of the sprain, your physiotherapist may recommend wearing an ankle brace to provide additional stability to assist with the initial stages of healing. 

Taping: Taping your ankle can also assist in providing extra support during the initial phases, and when returning back to play.

Balance and Proprioception Exercises: Proprioception refers to the body's ability to sense its position in space and detect the movement and location of its joints. The ankle joint relies heavily on proprioception for stability and coordination, but this can get temporarily impaired after an ankle sprain. When proprioceptive feedback is optimal, the body can make quick and accurate adjustments to changes in terrain or unexpected movements, reducing the likelihood of missteps that can lead to sprains. Single leg balance exercises, or exercises on unstable surfaces, such as wobble boards or balance pads, challenge the proprioceptive system and help to improve ankle function.

Strength and Power Exercises: Strengthening the muscles of the calf, foot and ankle through targeted exercises will help enhance muscle support, joint stability and reinforces the body's ability to respond effectively to sudden movements, reducing the risk of future sprains. Here are some exercises to get you started.

Graded Return to Activity:

In facilitating a return to performance after a lateral ankle sprain, our focus will be on collaboratively developing a structured plan tailored to your specific goals. We'll systematically reintroduce activities, beginning with controlled exposure to hopping, running and change of direction drills. Only after a thorough assessment and successful progression will we confidently provide clearance for your return to sport, ensuring a safe and gradual transition back to optimal performance.

What is the rehabilitation process following a lateral Ankle Sprain?

  1. Protection / Improve Symptoms: During this phase we will work to improve your symptoms to allow you to start rehabilitation, by working to reduce the pain and swelling to your ankle. We may provide soft tissue release to the calf and surrounding muscles, which due to tightness or inflammation may contribute to your pain. We may also recommend taping or bracing to reduce your pain and improve your confidence in use of the ankle.

  2. Load Introduction: Within this phase we aim to provide the foot and ankle with exercise to restore flexibility, and provide the ankle with some early loading balance, proprioception and foot intrinsic exercises, to restore normal walking patterns. We pay particular emphasis to the calf and supporting muscles of the foot and ankle during this phase, using our body weight, light weights and bands, with the goal of gradually progressing these. 

  3. Strength Development: Once you have regained pain free walking, full ankle range, we will continue to progress strength work around the foot and calf, whilst slowly introducing plyometric movements back in. We can assess your strength, jumping and landing abilities using our forceplates and strength testing equipment to evaluate where any lingering weaknesses may be. From this data we can further individualize your strength program from any deficits we may have found. We will provide you with a series of targets we want you to hit related to your age and sport. 

  4. Return to performance: For many, we see a reduction in jumping, running, landing and change of direction ability, which may contribute to risk of recurrence or a reduction in performance. If you're looking to return to higher intensity sport, we may assess your running and jumping ability using our forceplates and running analysis software. We will then provide feedback regarding these, and goals to hit regarding your jumping and running technique. Generally this will culminate into an exercise program which you can continue ongoing to reduce your chance or recurrence and maintain your performance going forward.

If you're looking for more specific advice or guidance in managing this condition, don't hesitate to reach out to the team at True Active Physiotherapy.

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