Ankle sprains are relatively common but typically reoccur without sufficient rehabilitation. Ligaments are damaged in a sprain, but ligaments are highly innervated and provide us with a great deal of proprioception necessary for balance when healthy and utilised.
“Sprain” refers to a ligament that has been over-stretched or torn to some degree, and ankle sprains are classified into three grades:
- Grade 1: microscopic tear(s)
- Grade 2: partial tear(s)
- Grade 3: complete rupture of ligament(s)
Local swelling, bruising, pain level, and difficulty weight-bearing increase with the grade. Bruising can track down into the foot, simply due to gravity. It does not necessarily mean there is an injury in the bruise’s location.
Lateral Ankle Sprains (Inversion Injury)
The most common ankle sprains occur when the foot turns in and the ligaments on the outside of the ankle are overstretched and damaged. Commonly occurring during running or jumping, a pop may be heard at onset as the foot turns in beyond its natural range, typically while weight-bearing.
Medial Ankle Sprains (Eversion Injury)
Less common. The foot turns out in eversion injuries, and overstretches the ligaments on the inside of the ankle. These ligaments are very strong so they are rarely sprained.
High Ankle Sprains
High ankle sprains are quite different to the others, as the damage is done above the ankle joint itself. This injury occurs when the foot rotates outwards relative to the leg, causing torsion through the strong ligaments between the tibia and fibula (shin bones).
Osteopathic Management
As always, your specific case will be the driving force behind your osteopath’s decision making. Most cases will involve a treatment plan that covers muscular balancing (stretching and strengthening) and mobilising in the short term. One very important part of the plan concerns proprioception. This is your body’s knowledge of where it is in space. Ligaments are largely responsible for this, so damage to them can throw your balance off in two ways. Exercises to strengthen the ligaments will slowly produce results, but have the dual benefit of also retraining the body’s knowledge of the ankle’s location.
General Advice
First aid for an ankle sprain is RICE: rest, ice, compression, elevation. This reduces swelling that may further stretch the ligaments and cause further instability. Manual therapy can help restore movement and proprioception later on if movement is inadequate or sprains recur. Lack of activity (proprioception, tone) and excess body weight (increased demand) can also increase the likelihood of ankle sprains. Warming up and cooling down before and after sport improves the range of the ligaments and muscles to reduce the likelihood of injury.
The NHS (and your car insurance provider!) recommends avoiding driving while ankle strength is reduced. Long term symptoms should not be ignored. There is a possibility of fracture or damage to cartilage so do seek a professional opinion if you’re not totally happy with your ankle. Even if the original sprain was years ago.
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