Sports most common injury – the ankle sprain
Sports most common injury – the ankle sprain
Lateral ankle sprains are amongst the most common injuries to affect athletes across all disciplines accounting for 15-30% of all injuries. Unfortunately, once you have had one ankle sprain their recurrence rate is high1. Rehabilitation with a focus on restoring your balance and proprioception (ability to sense where parts of your body are in space) is key to preventing future ankle sprains.
Mechanism of Injury
Ligaments act to support and stabilise the joints of your body preventing excessive movement. Often the most commonly affected ligament in an ankle sprain is the anterior talo-fibular ligament (ATFL).
The most common way to sprain your ankle is to roll, twist or turn beyond its normal range2. Sometimes this can follow an awkward plant, or following an excessive amount of force being applied e.g. from a tackle. This excessive range of movement can severely overstretch and damage the ligaments of the ankle causing inflammation, swelling and bruising.
Common Symptoms include:
- Inability to weight bear on the affected ankle
- Ankle pain, which can be mild to severe
- Decreased range of motion at the ankle joint
- Swelling and inflammation
- A popping sound during the injury
- Instability of the ankle (in severe sprains)
What can a physiotherapist do for you?
A thorough subjective (interview) and objective (examination) from a physiotherapist is usually sufficient to diagnose a sprained ankle. It is important to rule out the possibility of a potentially associated fracture but typically ankle sprains are graded on their severity 3:
Grade 1 sprain: Slight stretching and some damage to the fibres of the ligament.
Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
Grade 3 sprain: Complete tear of the ligament. Excessive instability occurs.
It’s important the severity of the ankle sprain is established as this will help to establish a time frame of when you may be able to return to sport or normal activity.
Typically, treatment and rehabilitation will then involve 4:
- Advice regarding POLICE (protecting, optimal loading, ice, compression, elevation)
- Soft tissue massage
- Joint mobilisation
- Range of motion (ROM) exercises
- Strength training
- Gait training (walking/running)
- Balance/Proprioceptive training
- Activity modification advice
- Return to activity program
Return to sport:
The key question for any athlete is when can I return? The answer isn’t always as straight forward as it might appear. Some things that we tend to consider in the decision-making process for return to sport after an ankle sprain are classified into five domains including:
1. Pain: Pain severity during sport participation and over the last 24h should be considered as essential criteria prior to clearing an athlete to return to sport.
2. Ankle impairments: As for ankle impairments, range of motion and muscle strength, endurance and power have to be evaluated.
3. Athlete perception: The perceived stability of the ankle and the confidence or reassurance the athlete feels, together with the psychological readiness for return to sport should be taken into account. The athlete should feel confident to load the ankle in both the rehabilitation environment and on field.
4. Sensorimotor control: A good proprioception and dynamic postural control are necessary items belonging to the sensorimotor control domain. Prior to returning to sport, the athlete should demonstrate adequate control of the ankle joint on unstable surfaces, when jumping and landing and in unpredictable situations.
5. Sport/functional performance: Regarding the sport and functional performance criteria, hopping and jumping, agility and sport-specific activities should be well tolerated. The final criterium for clearing an athlete to RTS is the ability to complete a full training session.
1.Fong, D. T. P., Hong, Y., Chan, L. K., Yung, P. S. H., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine, 37(1), 73-94.
2. Wright, I. C., Neptune, R. R., van den Bogert, A. J., & Nigg, B. M. (2000). The influence of foot positioning on ankle sprains. Journal of Biomechanics, 33(5), 513-519.
3. Lynch S. Assessment of the Injured Ankle in the Athlete. Journal of Athletic Training (2002) 37(4) 406-412
4. Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle sprains: evaluation, rehabilitation, and prevention. Current Sports Medicine Reports, 18(6), 217-223.
5. Smith, M. D., Vicenzino, B., Bahr, R., Bandholm, T., Cooke, R., Mendonça, L. D. M., … & Delahunt, E. (2021). Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework—an international multidisciplinary consensus. British Journal of Sports Medicine.