What is an ankle sprain?

An ankle sprain is an extremely common injury that is often overlooked and is classically treated with the mere Rest, Ice, Compression, Elevation (RICE) protocol until one feels ready to get back to their favourite activities.

Usually involving a plantarflexion and inversion mechanism of injury, the ankle ligaments (anterior talofibular ligament (ATFL) the calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL)) are stretched or even torn in more severe cases. Dislocation of the ankle joint and possible fractures may also occur.

Ankle sprains often occur in activities such as basketball, volleyball, netball and football as they require rapid changes in direction when a player, having jumped, lands on an uneven surface. The typical presentation of an ankle sprain may include pain and swelling over the lateral ankle, as well as difficulty to fully weight-bear through the injured limb.

“From a study of elite Australian basketball players, […] the rate of ankle injury was 3.85 per 1000 participations. Recurrence rates amongst basketball players is reported to be greater than 70%”

McKay et al (2001)

Grades of ankle sprains

Grade 1: light sprains that usually allow return to sport in 2-4 weeks

Grade 2: greater injury to ankle ligaments taking up to 4-6 weeks for full return to sport

Grade 3: full tearing of ankle ligament(s), needing 12 weeks or more for full healing and remodelling of tissues to return to pre-injury levels

The above timeframes vary on a case-by-case basis. However, it is extremely important that you go through a period of rehabilitation for a safe return to activity and minimise the risk of re-injury. Regardless of the grade of the ankle, the rehabilitation should involve training towards a level that prepares you for the demands and stresses of the sport or activity that you are returning to. Without going through to end stages of your rehabilitation, you may risk a re-injury by returning too soon.

Chronic ankle instability

You are more likely to re-injure the same ankle after sustaining an initial ankle sprain. From these recurrent injuries of the same structures, the ankle ligamentous structures become insufficient, resulting in proprioceptive deficits and increased ligamentous laxity. This is when chronic pain or instability can develop in the ankle. Normal ankle joint function become impaired and everyday tasks such as walking and work-related duties can be heavily impacted.

Taping and bracing

You may find yourself wanting a bit of support around your ankle when you first return to sport or activity. Often times, this is recommended as a short term strategy to provide some confidence whilst you re-gain familiarity with the demands and stresses of the sport or activity. However, it is important that you do not become dependent on the long term use of supportive braces or tape.

In saying that, taping or bracing can be effective in reducing such increased risk of lateral ankle sprain recurrence by restricting undesired and potentially harmful motion and allow desired motion.

Taping or strapping provides mechanical support and may enhance ankle proprioception (awareness of body position and movement) in high-risk activities such as basketball and can also be used as a protective mechanism during the healing and rehabilitation phase. However, tape application can cause reduced circulation from tight taping, skin irritation and diminishing effectiveness over time.

Bracing has several advantages over taping due to the ease of fitting and adjustment as well as the lack of skin irritation. Although the initial cost of a brace may be high, a good-quality, strong brace lasts a considerable time and may prove to be cheaper than repeated taping. On the other hand, bracing has its own disadvantages including possible slipping of the brace during use, the weight or bulk of the brace, problems with sizing and wearing and tear that will naturally occur with regular use.

Taping and bracing only supports the impaired ankle but do not re-train the underlying neuromuscular function of the ankle so these external measures are only effective during the period when they are worn. Current available evidence has shown it may take up to 8-12 weeks to strengthen the ligaments and muscles of the ankle and thereby reduce the risk of a recurrent sprain.

To begin your rehabilitation journey to restore your full ankle function again, contact Lexington Physio now for an initial assessment.