More than 23,000 Americans experience ankle sprains daily.
One simple misstep, and suddenly you have a rolled ankle or a sprained ankle.
Sprained ankles are one of the most prevalent musculoskeletal injuries in adults- both active athletes and couch potatoes alike. Ligaments are the bands of tough, fibrous tissue holding bone to bone. Damage occurs when one or more ligaments in the ankle are stretched or torn, causing ankle pain, swelling, and probably making walking difficult. Many adults attempt to “tough out” ankle issues and don’t get treatment.
If you experience more than slight ankle pain and swelling, get help from a physical therapist or a physician.
Without constructive treatment and rehabilitation, chances are that a severely injured ankle won’t heal well. Losing your range of motion and stability might result in recurrent sprains and more downtime down the line.
Recurrent ankle sprains are a troublesome problem- particularly for aging populations and adults who love to walk, bike, and enjoy activities that require weight-bearing and movement. Ankle ligaments can take weeks to months to heal properly – sometimes longer depending upon factors such as grade of sprain, general health, and activity level.
Anatomy of an ankle sprain.
The most prevalent kind of ankle sprain is an inversion sprain, also called a lateral ankle sprain. When the foot rolls inward, it pulls on and damages the ligaments of the outer ankle. The outer ankle has fewer ligaments than the inner ankle, making it naturally weaker and more prone to injury. Less common but equally problematic are inner (medial) ankle sprains and high ankle sprains- which damage ligaments that join the two bones of the lower leg just above the ankle. High ankle sprains usually happen during high-impact activities and are especially likely to cause ankle instability and subsequent sprains.
Ankle injuries- like a rolled ankle or an ankle sprain- lead to long-term ankle instability for around half of patients.
Common complaints from patients with chronic ankle instability include:
- Periodic “turning” or “rolling” of the ankle, especially during activities or on uneven surfaces
- Ankle pain and tenderness
- Continuing discomfort and swelling
- Feeling like the ankle is unstable or wobbly
Sprains impede neurologic and sensory signals.
In addition to stabilizing the ankle joint, our ligaments have another essential job: they send and receive sensory signals from the brain. This is called proprioception. Proprioception is your body’s perception of where it is in space. In simple terms, it’s how you know without looking if you are standing on a flat surface or your foot is placed on top of a step. This sense is vital when it comes to repetitive ankle sprains. Adults who have previously injured an ankle have likely overstretched their ankle ligaments, limiting the ability to send proprioceptive information to the brain. A lack of recognition prevents the brain from sensing when the ankle begins rolling over until it’s too late.
The long-term consequences of an ankle sprain depends on how much damage is done and how unstable the joint has become from it. The more severe the sprain, the more extended the recovery will be.
Grades of ankle sprain, as defined by the Harvard School of Medicine, are as follows:
- Minimal stretching of the tissues, no tearing
- Mild Pain, swelling, and tenderness
- Usually no bruising
- The joint remains stable with no difficulty bearing weight
- 1 – 3 weeks
- Partial Tear -Moderate pain, swelling, and tenderness
- Possible bruising
- Mild to moderate joint instability
- Some loss of range of motion
- Pain with weight-bearing and or walking
- 3 – 6 weeks
- Full tear or rupture -Severe pain, swelling, and or tenderness
- Considerable joint instability
- Loss of function and range of motion
- Unable to bear weight or walk
- Can be several months
It IS possible to strengthen a rolled ankle or ankle sprain.
To fully recover from an ankle sprain, restore your ankle joint’s normal range of motion and strengthen its ligaments and supporting muscles. Studies show that adults return to activities faster when functional treatment focuses on restoring ankle function, often with splints, braces, or taping rather than immobilization- or not moving.
Functional treatment generally involves three phases:
- RICE (Rest-Ice-Compression-Elevate) during the initial first twenty four hours will help reduce swelling, pain, and the chance of further injury**
- Range-of-motion and gentle mobility exercises within 48–72 hours. Generally, you can begin seated range-of-motion and stretching exercises within the first 48 hours and may continue until pain-free.
- Physical therapy to increase balance and endurance once recovery is underway
**If the injury to the ankle prevents weight-bearing or inhibits sleep, seek treatment from a medical practitioner as soon as possible.
Steps to minimize the chance of a rolled ankle and sprains:
- Quality Footwear & Orthotics. Choose appropriate, supportive shoes and orthotics based on your unique needs- gait, foot shape, activities, etc.
- Be Aware. Moving on uneven surfaces like gravel, sand, rocks, and sloped ground increases the stress on ankle ligaments.
- Strengthen your leg, foot, hip, and core muscles
- Balance. Strong “core” muscles and hips strengthen the lower body, enabling vital proprioception and balance.
- Brace or Tape. Adding support if needed can be a good idea- particularly during activities.
- Physical Therapy. Physical therapists guide you through specific stretches and exercises to restore ankle movement and strength. Critically, they create a plan of care to retrain your hips, core, ankle, foot muscles, and brain to work together.
How can quality footwear and orthotics help?
Ankle instability might not seem like an issue that proper footwear and orthotics can effectively treat, but studies from the National Institute for Health have proven them very effective. Both physicians and physical therapists have used orthotics as practical tools to treat both muscular and neural ankle instability.
Orthotics and supportive shoes help treat muscular problems in straightforward ways: by helping achieve proper alignment, relieving pressure from the injured tissues to allow the muscles and ligaments to heal, and aiding with balance on uneven terrain.
Enhanced ankle joint stability seems especially important for people with repeated rolled ankles and sprains.
The use of therapeutic taping or an ankle brace is a successful preventive approach that has the potential to reduce ankle injuries by 50–70 %. The Journal of Foot & Ankle Research states that the primary reasoning behind the cutback of ankle strains and sprains is that the tape and/or brace provides additional mechanical stiffness to the ankle joint. The extra support allows the ankle to remain more neutral as the foot strikes the ground. Additionally, braces assist in keeping the movement of the ankle joint within a healthy range, reducing the possibility of re-injury.
20% of acute ankle sprain patients develop chronic ankle instability.
Physical therapy for ankle pain and rolled ankles
A physical therapist will assess your ankle condition and overall situation and develop a set of exercises based on how the ankle is injured, how badly, and where it most needs strengthening. Below are some stages of activities your therapist might recommend.
Non-weight bearing with and without resistance
For these first exercises, sit on a bed or the floor with your feet in front of you.
- Dorsiflexion – Beginning with toes relaxed and pointed straight, flex your ankle, gently bringing the top surface of the foot upward toward the knee as far as you can without causing pain. Hold 15 seconds, then slowly reverse to the original position.
- Plantar flexion – Same as above in reverse. Starting in a relaxed position with toes pointed up, extend and point the toes away from the rest of your body like a ballerina. Gently stretch as far as is still comfortable, hold, and release.
- Inversion – With the toes pointing up, mildly turn the injured ankle inward towards the other foot and return to neutral.
- Eversion – From the same starting position, point your toes outward, careful not to push too far or turn the entire leg. Release.
- “Writing” the alphabet – With your ankle hanging freely from a seat or the side of the bed, gently draw the alphabet with your foot, with your big toe acting as the pen. Go slowly and with deliberate control.
- Your physical therapist will incorporate an exercise band or light weights when you’re ready.
Your physical therapist will indicate when the injured ankle is stable enough to begin weight-bearing activities.
- Calf raises, seated – Sit in a chair with both feet on the floor. Lift the foot of the injured ankle by doing the plantar flexion exercise (essentially) but using the floor to push off from.
- Standing weight shift – Standing with weight shifted onto the healthy foot, hold on to a stable object. For 5-15 seconds at a time, transfer a bit of weight – as tolerated- to the injured ankle, return, and repeat.
When your PT indicates you are ready, they will give the green light to put full body weight on your recovering ankle.
- Single leg stance – Stand upright, holding onto a stable surface for balance. Shift full weight on and off the injured ankle in 5-15 second increments.
- Standing calf raises – Again, using a balancing assist, shift total weight on the recovering ankle and raise the heel. Hold for 5-15 second increments, building up from there.
- Side stepping – Draw a line on the floor and step sideways over it one foot at a time, then return and repeat.
- Balancing – Fold a towel until it’s reasonably thick, or use a stability mat, then stand on it with your injured foot, using a stable surface as an aid. The ‘give’ should force the recovering ankle to balance, rebuilding strength and mobility.
A physical therapist can guide patients through when to work on a specific stage and when it’s appropriate to move to the next.
Don’t forget about Hip and Core Muscles!
Believe it or not, how the feet strike the ground when you walk and move has as much to do with your hips and core as they do with the surface you are landing on. Strong, solid hamstrings (back of the upper leg), quadriceps (front of the upper leg), gluteals (buttocks), and core muscles maintain alignment, support, and control as you walk and move. Any weakness within these crucial muscle groups creates irregular foot, ankle, knee, and hip forces, raising the risk of injury to the lower joints.
Balance & proprioception are KEY.
Improve balance and the body’s ability to sense movement, action, and location- also called proprioception- to avoid rolling an ankle.
How quickly a body responds to interruptions in balance plays a significant role in preventing recurrent ankle sprains. All of a body’s moving parts have sensors called proprioceptors. These tiny sensors constantly send and receive messages from the brain regarding your body’s position in space. The directives tell muscles what actions to take to keep the body balanced and upright. Most of our clients with recurring ankle sprains have impaired balance feedback.
Proprioceptive training is exceptionally effective in restoring balance feedback and preventing recurrent rolled ankles and sprains.
As the body becomes better able to fully bear weight without pain, proprioceptive training becomes key to achieving the recovery of balance and postural control. A wobble board is the most straightforward device for proprioceptive training. Patients stand on the wobble board on 1 foot and shift their weight, causing the board’s edge to scribe a continuous circular path and forcing the body to compensate immediately. This is a simple exercise that can be done at home. Wobble boards are very affordable and easy to store.
The ankles & feet are quite literally the foundations of the body, and as with a house’s foundations, cracks will appear if they are not maintained and strong.
Even as your ankle feels better, continue strengthening, balance, and control exercises several times weekly to keep your ankles strong. Stretching exercises should be continued daily- especially before and after physical activities, to help prevent re-injury.
Our physical therapists improve quality of life through hands-on care, education, and prescribed movement. Contact our expert physical therapists for a free, 15-minute phone consultation to get back to the activities you love without pain!
At Healthy Consumer PT, we provide expert advice and premier physical therapy services. Call our offices today at (517) 301-3623 to schedule an appointment