The ankle is a commonly injured joint in the body, sadly for most it is also one of the most complex and difficult to treat joints due to its anatomy and position. The injury that we will look at here is the most common form of ankle injury – the sprain. Ankle sprains come in two main forms:
Low ankle sprains – these are the most common forms of ankle sprains occurring due to an inversion/platarflexion over exertion, meaning the toes go down and in towards the body in a way that causes the ligaments on the outside of the joint (lateral ligaments) to become over exerted.
High ankle sprains cause disruption to the medial (deltoid) ligaments and the syndesmosis between the tibia and fibula. These types of sprains are rare and only count for only 10% of all ankle sprains. Mainly caused by an over exerted eversion movement at the ankle joint.
Both of these sprains are graded into 3 categories which depend on the amount of ligamentous damage that has occurred at the joint. Grade 1 being the least serious, grade 2 being middle severity with grade 3 being the most severe.
Damage from High Ankle Sprains occurs mainly to the anterior inferior tibiofibular ligament (AITFL), but like I said before this is a rare injury to occur.
Injuries that occur to this part of the ankle can cause major disruption to running biomechanics, the weaknesses left from poor rehab of the injury will lead to long term problems.
The main injury at the ankle is the low ankle sprain, this occurring mainly at the anterior talo fibular ligament (ATFL), Injury can also occur to the posterior talo fibular ligament (PTFL) and calcnealtalar ligament. As we said before this injury occurs due to a plantar flexion and inversion type movement. This occurs in many sports and daily life, just landing wrong off a curb is enough to cause serious damage to these ligaments.
Sports where high impact and landing are important such as basketball are at high risk of serious grade 3 ankle ligament injuries. When these injuries occur they can have a massive effect on your sporting play and exercise, however the recovery from these forms of injury are usually well tolerated.
To understand how to treat or rehabilitate the injury we must first understand the grades of injury that happen at the joint.
Grade 1 Ankle Sprain:
Grade 1 ankle sprains are caused by a stretch at the ligament. The symptoms are mainly pain and swelling. The majority of people can walk without crutches, but jogging, high impact movements and sports may be very difficult.
Grade 2 Ankle Sprain:
Grade 2 ankle sprains have a more severe tone caused by a partial tearing of the ligament or ligaments. There is significant swelling and bruising caused by bleeding under the skin. People will have pain with walking, but may have the ability to take a few steps.
Grade 3 Ankle Sprain:
Grade 3 ankle sprains are complete ruptures of the ligaments. The ankle will be significantly painful, walking will be difficult. Patients will have instability, and there will possibly be a giving-way sensation at the joint.
Pain and swelling are the most common symptoms in all three grades of sprain, these occur in differing severity depending on how much of the tissues are damaged. Bruising occurs around the ankle joint but this then travels down to the toes as gravity effects the blood flow.
Initial treatment –
First incidence of injury occurring –Rest, Ice, Compression, Elevation. (RICE) this is applicable for all grades of the injury, when it occurs make sure you follow the RICE protocol.
24-72 hours – Rest the ankle effected, use Ice packs 3-4 times daily for 15 minutes at a time, use ice in a towel, and never apply directly to skin. Do not compress the ankle joint with any bandages until after 72 hours have passed, this should allow any complications to show.
72 hours + – this is dependent on the grade, but compression bandages, ankle supports etc. are useful in maintaining joint integrity and should help prevent giving way. Crutches should be used if necessary when walking, rehabilitation should begin post 72 hours.
Grade 1 – this will require some form of ankle support, taping is especially good. Exercise of normal training may begin at an intensity of 40% of normal and this may be increased by 10% every 3 days until full fitness is achieved.
Grade 2 & 3 – non weight bearing exercises to help bring the ankle joint to full range of movement, once this is achieved then movements where impact on the joint is minimal. Deep squats is a good way to strengthen the muscles but it also uses the ankle in a way that puts weight through the joint but not in a high impact sense. Try three sets of 30 reps with a 60s rest 5 times per week. Once the ankle joint is strengthened appropriately then I would recommend this small workout that can be done 3 times per week to help rehabilitate and strengthen then joint:
3 sets of 30 w/60s rest – Deep Squats
5 sets of 20 w/ 60s rest – Calf raises with an appropriate weight
Developmental stretching of the ankle joint in inversion and dorsiflexion. 30second holds.
By. Chris Collins