Lateral Ankle Sprain & Instability

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Lateral ankle ligament sprains are one of the most common in people of all ages and sporting participation. Without the correct rehabilitation, a sprained ankle can lead to loss of movement at the ankle with reduced stability. This may result in reoccurring sprains and limited participation in sport or normal activities later in life. The aim of this information page is to ensure a safe and speedy recovery, using a modern scientific exercise approach, guiding you through each step on your return to normal activities and sporting goals.

The Ankle

There are two main joints at the ankle complex, the first is the ankle which is between the bottom of the tibia/fibula and the talus. This allows for the up and down movements (dorsiflexion/plantarflexion). The second main joint is the subtalar joint, which is between the talus and calcaneus and allows for the in and out movements (inversion/eversion). The stability of the ankle joint is maintained by the ligaments especially as the joint becomes less stable with increasing plantar flexion and inversion.

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What is a Lateral Ankle Sprain?

The most common type of ankle injury is a lateral ankle ligament sprain. This occurs when your foot rolls inwards (known as an inversion injury) which can affect the outer ligaments of the ankle – Anterior TaloFibular ligament (ATFL), CalcaneoFibular Ligament (CFL) and Posterior TaloFibular Ligament (PTFL).

Most lateral ankle injuries involve the ligaments and do not have any bony injury. Therefor X-rays are not usually used to evaluate ankle injuries, especially as ligaments don’t show up on x-ray. To screen for suspected fractures clinical professionals will use the Ottawa ankle rules which, have been shown to be 95% reliable in identifying a fracture. The severity of the sprain can be broken down into three different grades and the table below displays this.

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Initial Management

 Following a lateral ankle ligament sprain the main goals are to reduce pain, decrease swelling and protect the affected area from further injury. Previously we used RICE (Rest, ICE, Compression, Elevation) for injury management.However, rest can be harmful and inhibits recovery. Recent research has now advised we use the acronym POLICE.

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  • Protection
  • Optimal-Load
  • Ice
  • Compression
  • Elevation

The key term is Optimal-load, this replaces Rest.

Modifying your normal activities, by reducing prolonged activities on your feet is a form of optimal loading.

An ankle brace or taping can also help to protect the ankle joint and allow you to optimally load the ankle without aggravating your symptoms.

You can maintain your fitness using other forms of exercise that will not aggravate your ankle, such as swimming, cycling or aqua jogging. You may need to speak to your physiotherapist to discuss what your optimal load might be as it is specific to you but will help speed up your recovery process.

If your injury is very acute it is now recommended NOT TO TAKE ANTI-INFLAMMATORY MEDICATIONS FOR THE FIRST 72 HOURS POST INJURY,as this can affect the tissue healing. Other precautions post-acute injury are shown below.

Other things to avoid include:

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Flare Ups

An increase in pain or ‘flare up’ is common with ankle sprains. The key is to manage this effectively and efficiently. By using POLICE this can help reduce the initial pain. During a flare up managing your optimal load is important. You may need to reduce the stresses at the ankle and foot, reduce the amount of exercises and daily activities that you do. Over time gradually increase your activity back to previous levels. You can discuss optimal load with your physiotherapist.

The Exercises

Participating in an exercise program carries a certain element of risk for some people. You should consult with your physiotherapist before initiating this program to ensure your safety.

If you have any issues please do not hesitate to contact the physiotherapy department. If you feel light headed, dizzy or have issues with your breathing please contact your general practitioner (GP) immediately.

When carrying out this exercise program you may feel some discomfort at your ankle. It is important that the pain does not exceed3/10, where 10/10 is the maximal and 0/10 is no pain.

Level One

The main aim after any injury is to regain full movement of the affected area. This can be achieved through various stretches using pain as your guide. Dorsiflexion (or the upward movement of your ankle) is the most important as it allows us to walk, stand from a chair and squat normally.Lunge on step:Place your affected foot on a step and transfer your weight over your foot achieving dorsiflexion.Hold for 5 seconds and repeat 15 times. To do this as a stretch hold longer for 30 seconds and repeat 3 times.https://www.youtube.com/watch?v=2AdVZYZRRfw 2. Single Leg stand with head turns.

Proprioception is extremely important in regaining ankle stability and reducing the risk of re-injury.

Stand on one leg with your arms crossed and turn your head left and right. To make this more challenging, speak the days of the week out loud or close your eyes.

Time this for one minute and repeat 3 times.

https://www.youtube.com/watch?v=TFLjgvz7a9A 

  1. Isometric heel raises:

Push up onto your tip toes and hold this positionHold for 30 – 45 seconds, repeat 3 – 5 timeshttps://www.youtube.com/watch?v=Si-al7Tc_nw 

  1. Isometric foot Eversion:

In a comfortable position, situate your affected foot beside a stable object and push against that object by turning your foot outwardsHold for 30 – 45 seconds, repeat 3 – 5 timeshttps://www.youtube.com/watch?v=RfxoP9pKLoc

Level Two

  1. Monster walk

With a band around your knees, bend into a mini squat position. Slowly walk forward bringing your foot towards the opposite leg and back out to the side. Repeat this forward and backwards ensuring your knee tracks over your second toe.Complete 20 steps forward and 20 – 25 steps back, 3 sets.https://www.youtube.com/watch?v=n_HqAbjvmfM 

  1. Single leg stand on unstable surface:

Balance on your affected foot with your leg straight and slightly bent, then turn your head left and right.Continue in either position for one minute, completing 3 setshttps://www.youtube.com/watch?v=cyAHEwAE2Ik 

  1. Standing Heel raises

In a standing position push up onto your tip toesRepeat 15 – 25 times completing 3 setshttps://www.youtube.com/watch?v=58CNilZ9Ufs 

  1. Isometric Eversion with band

With a band fixed to a solid object and the outer part of your foot, apply tension to the band and slowly turn your foot outwards.Hold for 30 – 45 seconds, repeat 3 – 5 timeshttps://www.youtube.com/watch?v=PmGkkmGnlHY

Level 3.

  1. Squat on Bosu or unstable surface

With a band around your knees, select an appropriate weight. Perform a squat keeping your knees over your second toes, with your back straight and body weight evenly spread over both feet.

Repeat 15 – 25 times, completing 3 setshttps://www.youtube.com/watch?v=lGbu0fnbo1A 

  1. Lunge on Bosu or unstable surface

Standing tall, take a large step forwards with your injured leg and bend that knee until the opposite knee is approximately 5cm above the ground, then extend through the hip and knee to return to the starting position. Remember to keep your back straight throughout the movement.

Repeat 15 – 25 times, completing 3 setshttps://www.youtube.com/watch?v=OGNmixZ-wKQ 

  1. Jog on the stop with holds

Jog on the spot and stop on your affected leg, hold for 5 seconds and go again. You can make this more difficult by going faster or closing your eyes.Time this for one minute and repeat 3 times.https://www.youtube.com/watch?v=ZvmDyFfZ-vQ 

  1. Double/Single leg heel raises over step

In a standing position, with your heels over the edge of a step, push up onto your tip toes, hold for a few seconds then drop your heels down below the level of the step. Repeat with both straight and slightly bent knees. Once double leg is easy, progress to just the affected leg.Repeat 15 – 25 times completing 3 setshttps://www.youtube.com/watch?v=4BxtWQ80OUI 

  1. Eversion with band

With a band fixed to a solid object and the outer part of your foot, apply tension to the band and slowly turn your foot outwards. Keep this movement controlledRepeat 15 – 25 times completing 3 setshttps://www.youtube.com/watch?v=PmGkkmGnlHY Logos.jpg 

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