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Intro: What is an Ankle Sprain?
Even if you’ve never sprained your ankle, you know what it is. It’s fairly common knowledge that an ankle sprain is due to involuntary twisting of the ankle leading to pain on the inside or outside of the ankle that is often accompanied with bruising and swelling. Maybe it even swells up like a purple balloon!
If you have sprained your ankle before, then it’s likely it’s happened to you a few times. That’s because once you sprain it once, you’re more prone to reinjury as the ligaments are no longer as stable and strong.
Ankle sprains are one of the most common injuries in children, teenagers, and adults. They’re especially common in people who play sports that involve running or sudden changes in direction. Why so? Well you can picture this - you’re running after a soccer ball and all the sudden you need to change directions. So you pivot on one foot while turning the torso. That quick and sudden pivot can sometimes be too much for the ankle ligaments to handle if they’re not prepared for it.
Ankle sprains are especially common in runners. I wrote an entire blog about common running related injuries that you’ll also love. Have you read it yet? Check it out here.
Here are some crazy statistics about ankle sprains that may surprise you:
The ankle accounts for 10–30% of all sports injuries [Reference]
There are roughly 23,000 ankle injuries in the US each day [Reference]
20-50% of people who suffer from an ankle sprain can have long-term ankle instability as a result [Reference]
Mind blowing, right?! Now that I’ve got your attention, let’s dive deeper into what causes ankle sprains, the various types (or grades) of sprains, and how to best treat them. We’ve got lots to cover - let’s go!
Common Causes of Ankle Sprains
Ankle sprains are caused by an awkward rolling of the ankle that takes it beyond a range of motion you can control. This could be due to tripping, falling, landing wrong, a mis-step, rolling your foot off a curb or uneven surface, or an external force hitting your leg (like in sports).
Your ligaments are structures that are meant to control your joints movement, so when they are forced beyond their comfortable range of motion, they can get sprained.
Location and Muscles Affected by Ankle Sprains
Ankle sprains can occur in a few different areas impacting various ligaments at the ankle. Ligaments are structures that connect one bone to another.
An outer ankle sprain is the most common and accounts for about 85% of all ankle sprains. It’s called a “lateral ankle sprain” and occurs when the ankle inverts or rolls outward which lengthens the ligaments at the outer ankle. Some plantarflexion (pointing) can also occur. There are three ligaments there and they’re called anterior talofibular ligament (ATFL), calcaneofibular ligament, and posterior talofibular ligament.
An inner ankle sprain is less common. It’s called a “medial ankle sprain” and occurs when the ankle everts or rolls inward which lengthens the deltoid ligament at the inner ankle.
Those two sprains above are classified as low ankle sprains as they impact the ligaments that connect the fibula or tibia down to the bones in the foot.
You can also sprain ligaments higher up the ankle and that is classified as an upper ankle sprain. It is caused by an external force pushing the ankle outward while the foot is planted. It occurs at the ligaments that connect the bottom of the fibula and tibia together called the anterior and posterior tibiofibular ligaments (aka syndesmosis ligaments). This is much less common and only accounts for about 10% of all ankle sprains.
The impact of any type of ankle sprain is long-term, but especially upper ankle sprains. Once the ligaments are overstretched without control and sprain, then can remain lax or unstable for up to a year after the injury in 30% of people. [Reference]
Other long-term effects include a higher likelihood of re-spraining it and also future osteoarthritis at the joint.
Testing for Ankle Sprains
Testing for patellar tendonitis typically begins in Physical therapy with some range of motion (ROM) tests, manual muscle selective tissue tensioning tests (testing tendon strength), muscle length tests (testing flexibility), manual muscle testing, palpation tests, and special tests.
Symptoms of Ankle Sprains:
Swelling and/or edema
Typical test results: tenderness to palpation, decreased and possibly painful flexibility, weak strength testing, and possible swelling (edema) and bruising.
It’s typically suggested you perform 8-12 weeks of Physical therapy and that often yields great results. Then if there is no improvement, your Physician may suggest further testing like getting an Xray, MRI, or ultrasound to determine if there is more extensive damage or something else going on.
The main reason to get an Xray first would be if you have pain weight bearing. So if you can’t even take a few steps without severe pain and/or you’re super tender on the malleoli bones, you’ll want to see your Physician for an Xray to rule out a fracture first.
An MRI can diagnose an ankle sprain and classify it as grade I-III:
Grade I is mild - stretching of the ligament so quick recovery
Grade II is moderate - incomplete tear - may take 1-2 months to recover
Grade III is severe - complete tear - may take several months to recover
Conservative Treatment for Ankle Sprains
Disclaimer: The information provided is not intended to be a substitute for professional medical advice, diagnosis or treatment. Never disregard professional medical advice, or delay in seeking it, because of something you have read on this website. Never rely on information on this website in place of seeking professional medical advice.
Treatment for an ankle sprain varies depending on how severe the sprain is.
Physical therapy treatment should always be 100% customized to you: the stage of your injury (recent/acute or chronic), your history, your activity level, your job, your impairments, your abilities, and your goals.
With that said, the below treatments are general treatments often prescribed by Physical therapists for patellar tendonitis. Always consult your Physician before beginning any new exercise program.
In general, most people with ankle sprains progress better with functional treatment compared to being put into a cast and immobilized. So prioritize progressive overload of the ligaments slowly over time - controlled movement is better than no movement or activity at all. Exercise will help with tissue and collagen regeneration to accelerate the healing process to the ligaments which don’t heal as quick as muscles do, so they need all the help they can get.
Have you ever heard of PRICE? Say bye to that old phrase claiming that the best treatment after an ankle sprain was to Protect it (brace), Rest it, Ice it, Compress it (wrap), and Elevate it. The latest research is saying that’s not enough. Instead, we should be loading the ankle progressively.
Treatments for Ankle Sprains (from basic to advanced):
Ice, Elevate, & Compress (to reduce swelling)
Joint mobilization (level depends on stage of injury; plus mobilization with movement (MWM))
Range of motion exercise (within a pain-free range)
Stretching (plus contract-relax technique)
Strengthening exercise (including isometrics and neuromuscular stimulation) to load the ligaments progressively
Cardio (to help vascularization or bring blood flow to the area for healing)
Functional exercise (form training for squats, jumping, and running)
Manual/Massage: soft tissue massage (with the leg elevated to decrease swelling and edema)
Modalities: Ice, Ultrasound
Brace (if prescribed and more severe)(most Physicians prescribe use of the brace only for the first few weeks or during sports)
Ankle sprains should be feeling significantly better by weeks 8-12, but some symptoms can linger for up to a year if not properly treated.
If those conservative treatments don’t help then PRP injections, corticosteroid injections, or even surgery may be needed (especially if there are complete grade III tears and/or more severe injuries included).
Below are some products from Amazon that are often useful for addressing ankle sprains pain:
Physical Therapy Exercises for Ankle Sprains
In the following videos, I share how to improve range of motion, flexibility, balance, stability, and strength near the ankle.
Mission: Mobilize, Modify, Move
It’s my goal to ensure you learn three things with every injury blog post: how to mobilize your body, how to modify exercise, and how to optimize your movement.
Above I shared videos for ankle range of motion, stretching, mobility, strengthening, and balance work. It’s important to work on all of those aspects of the ankle to build up tolerance to load. Mobility at the ankle is especially important because if you have more control within a larger range of motion at the ankle, you’ll be less prone to injury. So practice all those exercises long-term to recover and also prevent future injuries.
Now, let’s cover some ideas for how to modify exercise if you have an ankle sprain:
Consider adjusting your workout split to focus more on the upper body and core more often - temporarily until your ankle feels better.
Modify lower body exercises by working within a comfortable range of motion, using lighter loads, slowing things down, and adjusting your stance. For example, if you’re doing a squat try these things:
Don’t go down as deep
Do it bodyweight or lighter load than usual
Go slower so you can really focus on form
Consider doing it in front of a mirror so you can watch your form
Try out different stances: narrow, wide, wider, toes forward, toes more turned outward
Throughout the day, modify any of the repetitive movements you make as that’s possibly the true cause of the inflammation. Or take more breaks while doing them. For example, if you stand at work all day maybe ask if you can sit instead or taking sitting breaks to elevate and compress the ankle.
Finally, if you plan to continue to strength train, I suggest you try these things out to move more optimally:
Warm-up appropriately prior to lifting. Try doing some ankle mobility exercises or calf raises first.
Definitely modify or skip these exercises temporarily if you have >4/10 discomfort: single-leg exercises, plyometrics, or balance work. Remember your ankle will likely feel fine with all bridge pattern (bridge, thrust, and frog variations) exercises still so focus more on those for the time being.
Then once you feel better, you can introduce those squat and hinge pattern exercises back in slowly to increase ligament tolerance.
While choosing strengthening exercises, consider doing more unilateral work so you can go lighter on the injured side temporarily. For example, lunges, Bulgarian split squats, step-ups, or single-leg leg extensions are unilateral. Whereas squats or box squats are bilateral.
During cardio, temporarily decrease volume or intensity of training. Cardio will be great for healing the ankle, but don’t go quite as intense and choose low impact cardio. For example, if you like to jog everyday, maybe you can temporarily replace it with biking, rowing, or cycling. Or you could also decrease the duration or intensity.
During sports, you may need to scale back the intensity and frequency of your training temporarily and consider wearing an ankle brace. Take time off jumping and high impact work - yes, rest, until you’re farther along in your recovery. Use that time to do rehab-based exercises until your symptoms subside. Then, you can build back up with more advanced strengthening exercises that load the tendon and eventually work on speed training and plyometric work.
To wrap this up, ankle sprains are very common and if you’ve experienced one before it’s very likely you’ll experience one again. Hopefully there isn’t a next time. But if there is, I am confident you’ll be better equipped to handle it now that you know how to best manage it.
If you found this blog helpful, comment below and let me know what the #1 take home lesson was for you. I love to hear from you all!
PS- Want more ankle mobility exercise ideas? Check out my online course Applied Mobility for mobility lessons and workout progressions for the whole body. You’ll learn to unlock your body and feel younger than ever before. Learn more here.
Stay well, Steph
Thanks for reading!
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