Ankle sprains are a common injury in the ankle, with lateral ankle sprains being the most typical.
Lateral ankle sprains can happen during any activity – misstepping on the kerb, walking on uneven grounds, or while doing sports.
It occurs when we roll or twist our ankle joints inwards beyond their normal limits during activities, over-stretching the outer structures (i.e., ligaments) and injuring them.
Take a look at the video below to get a better idea.
Do not fret if you’re experiencing one of these injuries… Let us look at some of the treatment options for this injury, and what exercises you can do to get you back on your feet!
Anatomy
There are 3 main ligaments on the outer side of the ankle:
1. Anterior Talofibular Ligament (ATFL),
2. Calcaneofibular Ligament (CFL), and
3. Posterior Talofibular Ligament (PTFL).
Image of 3 ligaments via https://www.nlhealthhub.com.au/what-is-a-lateral-ankle-sprain-or-rolled-ankle/
Classification of ankle sprains
The severity of the ankle sprain depends on the number of ligaments involved and the extent of the ligament tear from tiny tears in the fibres that make up the ligament to complete tears. The ATFL is usually the most commonly injured part followed by the CFL, and in severe cases, it may involve damage to the PTFL.
Image of ankle grade sprain via https://www.nlhealthhub.com.au/what-is-a-lateral-ankle-sprain-or-rolled-ankle/
Grade 1
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Slight stretching of the ligaments
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No ligamentous laxity (hypermobile joints)
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Mild swelling and tenderness
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No loss of function, i.e., no limitation in walking, running
Grade 2
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Partial tearing of the ligament
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Ligamentous laxity in ATFL
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Moderate swelling and tenderness
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Some loss of function
Grade 3
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Complete tear of the ligaments
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Ligamentous laxity in ATFL and CFL
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Severe swelling and tenderness
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Near total loss of function, i.e., unable or severe pain on any weight-bearing activities.
How do we know this injury is not something serious, like an ankle or foot fracture?
The set of Ottawa Ankle Rules is a screening tool to rule out ankle fractures. It is simple to execute and you can try this out on your own to check for fractures. Here’s a simple visual demonstration to palpate the ankle:
Image via https://www.physio-pedia.com/Ottawa_Ankle_Rules
5 Components to Palpate (press):
A. Bony tenderness along distal 6 cm of the posterior edge of the fibula or the lateral malleolus tip.
B. Bony tenderness at the base of the 5th metatarsal.
C. Bony tenderness along distal 6 cm of the posterior edge of tibia/tip of the medial malleolus.
D. Bony tenderness at the navicular
E. Inability to bear weight both immediately after injury and for 4 steps during the initial evaluation.
Symptoms
Symptoms may vary depending on the severity of the ankle sprain. You may experience one or more of these discomforts:
1. Tenderness and pain over the lateral ankle region,
2. Swelling around the ankle joint, and/or
3. Sensation of instability in the ankle joint.
The physiotherapeutic goals differ at different stages of the injury. In the acute stage, it is important to reduce pain and swelling and restore normal joint range of motion. Patients are advised to perform RICE therapy for the ankle during this stage.
RICE is an acronym for Rest, Ice, Compress, and Elevation.
The video below shows how to Ice, Compress, and Elevate.
Place the affected ankle on an elevated surface. Place an ice pack (+ towel to reduce the risk of ice burns) on the swollen area. Wrap the ice pack around the ankle firmly with a towel to keep it in place and to achieve mild compression to the area.
Additionally, patients may require medication(s) to reduce pain and swelling. A doctor or pharmacist can advise you on that.
Although it may be painful to bear weight during the acute stage of injury, we still need to normalize one’s gait patterns. This can prevent the loss of muscle strength during this phase of the recovery.
Over time, as the patient is able to tolerate more weight-bearing movements in the ankle, functional exercises such as single-leg balancing and heel raises can be added to improve ankle strength and control. Incorporating hip-strengthening exercises for patients with ankle injuries is also essential. Hip strengthening exercises can help improve the patient’s postural control in dynamic movements, which is important in preventing recurrent ankle sprains.
Follow along with the exercise videos below to strengthen your ankles!
Calf stretch
Stand an arm’s length away from a wall or a pole (see photo above).
Take a step forward with your right leg while placing both hands on the wall/pillar for support. Then, extend your left leg backwards, pressing your left heel into the floor. Ensure your hips are squared with toes pointing forward, keeping the back heel flat on the ground as much as possible.
Move your body forward by shifting your right knee slowly towards the wall/pole while maintaining both feet flat on the ground. You should feel a good stretch in your calf muscle on the back (left) leg.
Hold it for at least 30 seconds, and do the same with the other leg. Repeat this alternating stretch three times.
Ankle eversion with resistance band
This exercise targets the peroneal longus muscles, which helps to stabilize the ankle joint, and reduce the chances of turning the ankle inwards excessively.
Wrap a resistance band around your left foot. Loop the other end either around your other foot or a sturdy object. Slowly move your foot and ankle outwards, against the resistance band. Try moving it as far as possible without experiencing pain. Repeat 10 times, and do the same with your other (right) foot!
Single-leg balance
This exercise can help improve your overall balance.
Stand close to a wall for support. Without over-straightening/locking your knees, stand and balance on one leg for about 60 seconds. You can progress this exercise by standing on a less stable surface (e.g., foam pad, yoga mat, etc.) to challenge your balance further.
Heel raises
This exercise improves ankle mobility and strengthens the muscles around the feet and ankle.
Start by standing at the edge of a step, holding on to the wall or handrail for support. Keeping the legs straight, press down on the balls of the feet and raise both heels up. Slowly lower your heels until there is a slight stretch in the calf muscle. Do this 10 times.
Step ups
This exercise improves balance and coordination by building lower limb muscle strength.
Find a place with some steps or a sturdy platform, preferably with a handrail or wall for support. Place one foot on top of the step and ascend. Ensure the hip, knees, and ankle joints are in line when you step up. Return to the starting position by bending your hips and knee, and carefully descend backward. Aim to repeat 10 reps on each leg.
Bulgarian split squat
This exercise is similar to step-ups. It aims to improve balance and coordination by building lower limb muscle strength.
Find an elevated platform and turn your body so that you are facing away from it. Lift your left leg and place the balls of the foot on the edge of the platform. Try to position yourself so that your left leg is always kept slightly bent. From this position, bend your right knee slowly to allow your left knee to reach as near to the ground as possible. Look straight ahead and engage your core and glutes. Return to the starting point by straightening your right leg. Keep your hips, knees, and ankles aligned, with your torso upright when doing this exercise. Aim for 10 reps on each leg.
When patients stop complaining of pain in daily activities, have regained strength in ankle muscles, and can balance better, ankle rehabilitation can move on to the next phase.
The goal in the next phase of rehab is for a safe return to sports or normal activities, and to prevent future ankle sprains. Rehab in this stage will consist more of multi-direction exercises, plyometrics (e.g., hopping, jumping), agility, and activity-specific drills.
What The Movement Laboratory can do to help
Our well-trained physiotherapists will assess the extent of the injury. They will check your ankle mobility, muscle strength, and balance. If there are movement deficits, manual therapy can be used to improve the mobility of your ankle. They will work with you to develop an exercise program to promote recovery and improve ankle functions.
Contact The Movement Laboratory at +65 9755 3516 to book an appointment or for any enquiries.
In the meantime, check out another article we have on feet!
References