Lateral ankle sprains (LAS) are common musculoskeletal injuries with a high prevalence among the general population and individuals who participate in sports. Despite the high prevalence, it is reported that approximately 50% of individuals who sustain a LAS will seek medical attention; and the worrying statistic? A large proportion of those who sustain a LAS will develop chronic ankle instability (CAI).

Chronic ankle instability (CAI) can be defined as persistent complaints of pain, swelling and/or giving way in combination with recurrent sprains for at least 12 months after the initial ankle sprain. In addition, structural changes may be associated over this period including joint degeneration and osteochondral lesions. 

Anatomy 

Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the ankle help to keep the bones in proper position and stabilize the joint. Most LAS occur on the lateral ligaments on the outside of the ankle. These lateral ligaments are a combination of ligaments that are collective called the lateral collateral ligaments and comprise of the anterior talofibular (ATFL), the calcaneofibular (CFL), and the posterior talofibular ligaments (PTFL).

Lcl Tears

Presentation

Patients often “know” when they’ve sprained an ankle. Below is a list of a few of the typical things patients will present to us with in the clinic:

  • Limping is a telltale sign! But sometimes patients come in with crutches
  • Bruising along the outer and/or inner aspects of the ankle joint, around the prominent ankle bones  and sometimes over the surface of the upper ankle
  • Tenderness along the ankle bones
  • Pain and soreness when rolling the ankle in or out
  • Instability of the ankle – a feeling of giving way

Assessment and Diagnosis

First and foremost, our role is to rule out any major red flags including fractures. Currently, a useful tool we use both on field and in the clinic is the Ottawa Ankle Rules, which assists physios to determine if there is any chance of fractures and reduce the need for any unnecessary imaging. 

Ottawa Ankle Rules

A typical assessment with an ankle sprain physiotherapist would start with some light palpation to determine which ligaments are likely to be affected. Light palpation around the ankle and / or in combination with some ligament stretching would shed light on which of the ligaments may be damaged or injured.

Following this check, we would then check range of motion. In the early stages, range may be limited and painful. As range of motion improves, a common test we use is the ‘Knee to Wall’ test. We look to restore range of motion typically to 10-12+ cm.

Knee To Wall Test

Grades of Ankle Sprains

Having determined the ligaments involved, we can grade the severity of injury and begin determining time frames for healing and recovery. The typical grading system is summarised as below:

Grade I Mild – Little swelling and tenderness with little impact on function

Grade II Moderate – Moderate swelling, pain and impact on function. Reduced proprioception, ROM and instability

Grade III Severe – Complete rupture, large swelling, high tenderness loss of function and marked instability

Ankle Images Sprains

Management

A 2018 clinical guideline was developed with the existing up to date research, lead by Vuurberg and colleagues. The following were their recommendations for management and guidelines that many clinicians will follow.

RICE
Rest, ice, compression and elevation have typically been the go to advice in the earliest stages of an ankle sprain. However there is little scientific support for the use of RICE alone and if applied, should be in combination with exercise therapy which we will touch on below.

Immobilisation
A hot topic of “should I tape or use a brace” is often asked in our clinic. Current guidelines suggest the use of external support for 4-6 weeks prove superior to complete immobilisation (within a cast) or loose support (like tubi-grip or elastic bandage). In the early stages, we’ll often use taping to initially provide support, and will often guide patients in perhaps investing in a lace up or semi rigid brace if we deem it necessary for our long term goals.

Ankle Taping
Joint Mobilisation
Physiotherapists are trained in joint mobilisation and can apply manual joint gliding and manipulations to help aid joint movement. Current evidence suggests that manual joint mobilisation can provide short term increases in ankle joint range of motion and decrease pain, and is even more effective when paired with an exercise program.

Exercise
Following any LAS, exercise remains an integral part of the ligament management. Early exercises are encouraged and will often comprise of neuromuscular (brain to muscle) and balance (proprioceptive) exercises. Exercise programs that are initiated early have been shown to reduce the prevalence of recurrent ankle injuries and improve ankle stability.
Single Leg Squat Ankle Flexibility

Key Take Home Messages!

  1. Ankle sprains are common and can be managed very well with a combination of early functional immobilisation, controlling inflammation and progressing to weight bearing type exercises as soon as possible
  2. Prevention of chronic ankle instability and injury should include progressive ankle strengthening that also have neuromuscular and proprioceptive exercises that challenge and stimulate the balance systems

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Mana NankivellMana Nankivell
00:38 18 Apr 23
I highly recommend Trent and the Physio Fit team.I sustained a knee injury (fat pad impingement) in a half-marathon around 18 months ago, and after 12 months of seeing a (different) physio and sports doctors without any improvement, I was told by the doctor that I would "probably just have to put up with the pain".I booked in with the team at Physio Fit for another opinion, and it was the best decision I ever made. Trent put together a very manageable rehab plan for me and was quick to respond and adapt when something didn't work out. In the past 6 months, I've gone from not being able to walk without pain or even think about hiking, running or cycling without my knee flaring up, to running my first post-injury 5.5km trail run and hiking 10km with a 10kg pack!
Laura O'ConnorLaura O'Connor
08:47 05 Feb 23
This clinic is the pinnacle of physiotherapy in Adelaide. Ive seen a couple of different physios at physiofit over the years for different injuries and the experience has been absolutely amazing each time! Highly recommend seeing the team here for all your physio needs!
Ryen ArcherRyen Archer
02:50 03 Feb 23
Corey is absolutely fantastic, worked out my issues and we have been working to improve them for a few months now and all I can say is I am feeling a million times better! thanks physio fit! Keep up the great work!
Amy SzyndlerAmy Szyndler
02:44 03 Feb 23
I attended Physio Fit to get my tennis elbow treated. Always a friendly greeting from the lovely reception staff, and my physio, Corey, was fantastic; very friendly, knowledgeable and provided treatment that was personalised and holistic. Following Corey's advice and exercise regime helped me get back to the activities I enjoy, pain-free. Highly recommended.
Debbie MossDebbie Moss
07:21 02 Feb 23
Have been taking my daughter here for quite a few months now for ongoing back issues. The care that she has been given through her Physiotherapist Corey, has been fantastic. Everything has been explained and if exercises have needed to be modified he has. Would thoroughly recommend this place for any Physio needs. All staff that we have dealt with have been friendly and professional. A great team and environment.
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