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Ankle Sprains and Chronic Ankle Instability

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By far ankle sprains are the common sports related injury. In fact, there are over 28,000 ankle sprains per day in the United States. Furthermore, approximately 30% of people who experience an ankle sprain will go on to develop chronic ankle instability. The most common way a person sprains their ankle is by “rolling” the ankle which quickly stretches out the ligaments on the exterior portion of the ankle. The main purpose of these ligaments is to keep the ankle stable. Over time the ankle eventually heals, but these ligaments are now less taut which results in the ankle feeling less stable, which leads the person more prone to spraining their ankle in the future.

There are several risk factors for developing ankle sprains. First of all women are 25% more likely to sprain their ankle than men. People who demonstrate less range of motion in their ankle joint are also at risk for developing a sprain. People who are very active or athletes are more likely to develop a sprain, especially if the sport is field hockey, volleyball or football. Whenever we are walking or running on uneven terrain we are at greater risk for developing a sprain, a good example of this is someone hiking on a rocky slope. Lastly, one of the greatest risk factors for developing a sprain is a previous history of ankle sprains.

There are 3 main grades of ankle sprains. Grade 1 means that one or multiple ligaments were stretched out. This causes inflammation and swelling and usually a moderate amount of pain, but the person can still usually bear weight through the affected leg. In grade 2 sprains the ligaments are actually partially torn. The symptoms are usually worse, bruising/redness can also be present and the person will usually have difficulty bearing weight through the ankle. Grade 3 sprains are where the ligaments are fully torn. Typically these types of sprains are the most painful and in some cases require surgery. A person with a grade 3 sprain almost always has difficulty bearing weight through their ankle. Chronic ankle instability is a condition where a person’s ankle becomes so unstable they are repeatedly spraining their ankle even while walking on a level surface. This condition can make performing recreational activities nearly impossible and in some cases can make a person at risk for falling.

For a grade 1 sprain resting, icing, compressing and elevating the ankle will reduce the swelling and inflammation. Also actively using the muscles in the ankle will also reduce the swelling. This can be accomplished by writing out the alphabet every waking hour with the affected ankle in a non weight bearing position. Because of the strong risk factor of developing chronic ankle instability even a grade 1 sprain may require physical therapy. This will include balance training, using an air cast or taping to aid in stabilizing the ankle and to also provide the user with feedback for if/when the ankle beings to “roll” again. Although a therapist cannot tighten the ligaments after they are stretched out the physical therapist can incorporate exercises that focus on strengthening the muscles around the ankle joint, which will increase the stability of the ankle.

For grade 2 sprains a similar plan of care will be developed, but the recovery time is usually longer. For grade 3 sprains surgery may be performed, but a person who is not an athlete can attempt conservative management before surgery. Once pain, swelling and inflammation are no longer present the physical therapist can use functional performance assessments to test whether the ankle is stable enough for the person to return to activity or their sport.
If you have recently injured your ankle call Total Performance Physical Therapy for a consultation today.

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