Ankle sprains are pretty common foot and ankle injuries that happens when our ankle twists or turns beyond its normal range of movement. It can be pretty painful – I remember the day I sprained my ankle during my first time learning ice skating, man, my ankles were pretty painful. I couldnt walk properly for a few weeks after, with lots of sharp pains in between.

It can be pretty painful.

What happens during an ankle sprain is that the over-stretching of the ankle beyond the normal range of movements causes ligaments of the ankle (that hold the ankle together) to stretch and have minor tears. If it’s bad enough, it can be a full ankle ligamental tear too, which will cause lots of ankle instabilities and will require surgery to fix the torn ligament.

In the United States, there about about 20,000+ cases of ankle sprains that happen every day. Imagine that. In the world of sports injuries, close to half of sports injuries are ankle sprains. That’s why it’s a pretty common condition that most physiotherapists treat around the world.

Of course, there are people who are more at risk of spraining their ankles, and they are:

• younger athletes
• uniformed force such as police offices and the military (due to their stiff shoes)
• people who have had ankle sprains before and didnt go for ankle physiotherapy tends to have higher chance of ankle sprain recurrence (due to changes in proprioception in the ankle from earlier ankle sprains)
• people who are more sedentary
• when using new shoes
• individuals who are active and frequently jumps, runs and changes directions quickly especially doing an athletic activity
• dancers
• etc

As a general rule of thumb, physios will help patients with ankle sprain by:

• managing and reducing the ankle pains
• protect the ankle’s stability and avoid reinjury especially during time of healing
• restore ankle balance, movement, strength

What are ankle sprains?

As I shared earlier, ankle sprains happen when there is an over-stretching of the ankle (twisting or turning) that causes the ligaments that connects the leg, ankle and foot to be injured.

That being said, most of the time, the ligaments that gets injured tends to be the ligaments on the outer side (lateral) of the ankle, because of the way our foot is and the mechanics of walking and running on our feet. Of course, the ligaments on the inner side of the ankle can be injured too, but it’s just less frequent.

Most ankle sprain can take anything from 4 weeks to 3 months to fully heal. Most patients will experience their ankle pains decreasing a lot by the 4th week, and their ankles can fully strengthen by 12 weeks (3 months)…

…a badly sprained or repeatly sprained ankle can take 6-12 months to recover fully, with ankle physiotherapy.

Sadly, up to 75% of patients with ankle sprains tend to have recurrent ankle sprains, which simple means that “if you sprained your ankle once, you may sprain it again and again”. The reason why this happens is because of the combination of

1. ligaments take time to recover, and as long as they’re not fully healed, they can be easily reinjured
2. we’re on our feet and ankles a lot, so that increases the chance of ankle sprains and re-injuries
3. once you’d sprained your ankle once, the balance/righting centers that’s located in your ankles may be disrupted, causing your ankle’s ability to right itself on change of surfaces/altitude to go off. This definitely increases chances of ankle reinjuries a lot, and can be treated with ankle physiotherapy programs
4. weak / unstable ankles due to prolonged rest, sedentary lifestyle or accidents

How does an ankle sprain feel like?

Hmm…I really dislike ankle sprains and pains. After going through that season of post ice-skating ankle sprain, I can definitely relate. You may experience:

1. pain
2. inability to put weight or stand on the injured foot and ankle (walking may be terrible too)
3. ankle stiffness
4. definitely weakness
5. instability
6. lots of uncertainties on how much weight, load you can put on your feet

of course, the more severe the ankle sprain, the more intense the experiences be it pain, stiffness etc

I felt pain immediately upon my ankle sprain; and within the same hour itself, I felt multiple episodes of re-injuries as I tried to walk (had to go home) and each time I stepped on my foot, the exact same sharp pain came back again and again. I think there was at least 15-20 episodes of sharp ankle pains during my first ankle sprain experience.

Some patients may notice swelling and bruising (greenish, bluish or blue-black tinge); and the ankle area will tend to be tender (painful to the touch) and maybe you may experience throbbing in tandem with your heartbeat.

For badly and severe ankle sprains, you may feel or hear a popping or snapping sound, and this usually means something tore (or possibly ankle fracture too). For these, you will know fairly quickly because they come with a lot of swelling and increasing pain.

How do you diagnose ankle sprains?

The proper way and recommended way is of course to go see a doctor and get an ankle x-ray to make sure that there are no fractures.

If you see a physiotherapist, what they will do is

• oral question: asking how did you get injured, did you feel anything tear / pop, what level of pains etc
• physical exam: checking for swelling, tenderness, pain, movement, flexibility
• observation: how you move your foot, stand, walk

And then you’d be classified:

• Grade 1 (mild). The ankle ligament is overstretched. This is the simplest and easiest to treat and take shorted of time to recover.
• Grade 2 (moderate). The ligament is overstretched or partially torn. This one more complex and takes more time.
• Grade 3 (severe). The ligament is completely torn (100% ligament rupture). For this, you may very likely require surgery to fix the torn ligaments and extended ankle physiotherapy to restore movement, stability and strength over months.

If it’s grade 3, you will very likely be sent to an orthopedic doctor almost immediately.

How physiotherapists can help with ankle sprain

During the first 24 to 48 hours following your diagnosis, the physiotherapist may advise you with:

• Rest the area by avoiding any activity that causes pain.
• Cold therapy ice packs to the area for 15 to 20 minutes every 2 hours.
• Consult with an orthopedic doctor for further services, such as medication or diagnostic tests.
• Walk on the affected foot as soon, and as much as you are able, without making the pain or swelling worse.
• Use crutches or other walking aids to help alleviate pain and support balance.
• Wrap your ankle or use an ankle brace for support and to prevent swelling.

These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing.

The physios will also work with you in/with:

Pain and swelling reduction and management. You will learn how to avoid or modify your daily and sports activities to prevent aggravation of your ankle and support ankle ligament healing. You may also be place under specific treatments such as

• cold therapy / heat therapy
• rehab tech such as ultrasound therapy, radio-frequency therapy which will accelerate soft tissue healing (ligament in this case)
• electrical stimulation
• taping (sports taping, rigid taping)
• specific foot and ankle exercises
• hands-on therapy, such as manual therapy and mobilization of joints and soft tissue

Increase ankle joint motion and movement. The focus will be to improve and restore normal full movement in the ankle. Usually we will start off with gentler, safe “passive” movements which means we will do the movements for you (hence the term passive); and as the injured joint improves, we will improve the difficulty to active and later on to strengthening and balance.

Improve soft tissues nearby, which can mean managing tight muscles, tendons of ligaments surrounding the ankle, to stretch them out.

Improve Flexibility. We will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.

Build on stamina, strength and balance. This translates to endurance, power and stability. For these you can expect gradual/graded exercises that will be slowly introduced to you to build your endurance, power and stability in dynamic movements.

Agility, return to activities and sports. For people who are very active and play sports, we will focus on agility and higher balance work specific to your sports and daily routines.

If you need to undergo ankle surgery – Most of the time, patients do not need corrective surgery for ankle sprains – typically for very bad injuries such as ligament ruptures or ankle fractures. You will definitely need ankle physiotherapy in the event of ankle surgery for the same above mentioned goals.

During the first 24 to 48 hours following your diagnosis, the physiotherapist may advise you with:

• Rest the area by avoiding any activity that causes pain.
• Cold therapy ice packs to the area for 15 to 20 minutes every 2 hours.
• Consult with an orthopedic doctor for further services, such as medication or diagnostic tests.
• Walk on the affected foot as soon, and as much as you are able, without making the pain or swelling worse.
• Use crutches or other walking aids to help alleviate pain and support balance.
• Wrap your ankle or use an ankle brace for support and to prevent swelling.

These self-treatments will allow you to be as active as possible with the least amount of pain, and will help speed healing.

The physios will also work with you in/with:

Pain and swelling reduction and management. You will learn how to avoid or modify your daily and sports activities to prevent aggravation of your ankle and support ankle ligament healing. You may also be place under specific treatments such as

• cold therapy / heat therapy
• rehab tech such as ultrasound therapy, radio-frequency therapy which will accelerate soft tissue healing (ligament in this case)
• electrical stimulation
• taping (sports taping, rigid taping)
• specific foot and ankle exercises
• hands-on therapy, such as manual therapy and mobilization of joints and soft tissue

Increase ankle joint motion and movement. The focus will be to improve and restore normal full movement in the ankle. Usually we will start off with gentler, safe “passive” movements which means we will do the movements for you (hence the term passive); and as the injured joint improves, we will improve the difficulty to active and later on to strengthening and balance.

Improve soft tissues nearby, which can mean managing tight muscles, tendons of ligaments surrounding the ankle, to stretch them out.

Improve Flexibility. We will determine if any foot, ankle, or lower leg muscles are tight, begin to stretch them, and teach you how to stretch them.

Build on stamina, strength and balance. This translates to endurance, power and stability. For these you can expect gradual/graded exercises that will be slowly introduced to you to build your endurance, power and stability in dynamic movements.

Agility, return to activities and sports. For people who are very active and play sports, we will focus on agility and higher balance work specific to your sports and daily routines.

If you need to undergo ankle surgery – Most of the time, patients do not need corrective surgery for ankle sprains – typically for very bad injuries such as ligament ruptures or ankle fractures. You will definitely need ankle physiotherapy in the event of ankle surgery for the same above mentioned goals.

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