Sports Injury Focus- Ankle Sprains

We’ve seen lots of people with ankle injuries over the years. The common story we hear when clients come in, is that they have sprained the ankle ages ago and started to notice pain in the knee, hip or back on the same side as the ankle injury. There is always a knock on effect, and what most people don’t realise is lack of range of ankle movement( particularly what we call dorsiflexion) and loss of balance and strength and control at the ankle are the number one reasons why these problems persist.

Most people rest, take painkillers, wear a support and just assume that when the pain goes that the foot and ankle has fully recovered. Read on to get the correct information about how to properly manage a foot and ankle injury….

Ankle Sprains – Signs and symptoms:

Likely to have landed awkwardly, twisted, or fallen causing pain, stiffness and immediate swelling, mainly on the outside of the ankle joint, below the ankle bone. A ball of swelling will be noted or tracking of bruising down the lateral border of the foot. This is what we call ecchymosis. In my experience the worse this is my more likelihood you have a more serious ligament injury or a fracture. Injuries are classed in different grades, and upon diagnosis we will advise you to either wear a brace, get some crutches to offload the area, or we may advise an x-ray to exclude any bony injuries.

Please be mindful that the info below is a very basic guide. Please consult a health professional in order to get a proper idea of the severity of your injury before proceeding with anything we have provided below.

* Week 1 

We use the regime called P.O.L.I.C.E. Protection, Optimum Load, Immediate ice, compression and elevation. Strapping the joint will also help.

Begin gentle walking ASAP. Often 3-4 days post injury. Note it is expected (and okay) to be painful. However, straight line walking only.

None whatsoever twisting or turning of the ankle joint can be tolerated in week 1. Swimming is encouraged when possible and if pain allows.

From a Physio point of view – deep friction massage and very gentle massage of calf and Achilles would begin after just 4-5 days. We also use ultrasound and interferential at this stage. Strapping can also help.

* Week 2 

Very gentle (but prolonged) walking on the flat, is vital and to be encouraged. Towards the end of week 2, the goal will be for gentle jogging on a treadmill.

Swimming continues, cycling and cross trainers are all ok.

From a Physio point of view – massage continues of ankle ligaments and of the calf and Achilles tendon to prevent tightness and future problems. Stretching of all muscle groups is a must and balance work is now added to both ankles. Ankle mobility is important too.

* Week 3 

Exercise and CV work is increased.

Straight line running is picked up and athlete will aim to be at three quarter pace by the end of this phase.

Slowly, but surely, uneven surfaces are introduced and twisting and turning begins to be allowed.

From a Physio point of view – all deep massage work continues, muscles and ankle joint are stretched to the max and proprioception exercises are now top priority along with full movement of the ankle joint.

* Week 4 

Athlete returns to training and possibly performance. CV work increase and continues.

From a Physio point of view – all treatment and stretching continues for approximately 3-4 weeks and athlete pays attention to proprioception exercises. Lots and lots of balance work. We will also have a look higher up the chain and make sure that the calf muscles, hamstrings, gluteals and quads are doing what they should be doing.

Review of recovery: 

Take it very easy early on. But in the case of nearly all ankle sprains, too much rest will be harmful.

Stretch and mobilize the injury at just the right time and no ankle injury can ever fully recover with prolonged rest.

Secret Tip(s): 

Too much rest in the first few weeks will increase the likelihood of re-injury and a plateau. Do not be fooled by lack of pain when walking straight – Twisting and turning “pain free” must be achievable.

Note: It’s not uncommon for ankle sprains to feel not much better even 6 weeks down the line. And it’s often because of too much rest in the first few weeks.

Stay off the beach and avoid uneven woods/hilly areas when running, for at least 3 months post-injury. Don’t be fooled by the lack of pain after two weeks either.

It does not mean you are fit to play or run and if you haven’t followed all of the Protocols listed above, you will damage the ligament again sometime soon.

If you’d like more info on this, and some further easy, actionable tips on other sports injuries too. We have a free guide that we can send you. Connect with us on 01344 489398 or email us on bracknell@applephysio.com and tell us what’s going on. 

A member of the team can take your details and we can email you a copy.

About the Author: Leslie Abrahams and the Apple Physio team


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Leslie is a Physio, Pilates Educator and Rehab Specialist who has a special interest in Spinal Treatments, lower limb injuries, and has vast experience dealing with patients post injury or surgery. Every week, for over 20 years, 100’s of people aged 30-64+ have consulted the Apple Physio team looking for answers to concerning questions about, and for, a fast end to their health worries and physical pains and stiffness.

 Leslie is a Master Trainer for the world renowned Australian Physiotherapy and Pilates Institute(APPI). He is regular key note speaker at conferences and travels internationally to present on modified exercise for rehabilitation. Leslie is the Director of Apple Physio Clinics situated in Bracknell and Windsor. Berkshire’s Specialist Private Physiotherapy Practice for People in their 30’s. 40’s, 50’s and 60’s and above, who want to keep healthy and active.

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