“I just came down on someone’s foot, it’s no big deal”
“I think I’ve rolled this ankle in the past, but I doubt it’s related to this injury”
“I’ve sprained this ankle a bunch of times but never too bad”
“Rest a couple weeks and then you’ll be fine to return to activity”
Any of this sound familiar? The annoying re-occurring ankle sprain is something we hear about a lot. We frequently see it in the sports world with cutting, jumping and quick direction change but this injury has been known to rear its ugly head with the general population as well. That re-occurring aspect often manifests when rehab is not utilized after the first sprain.
When the ankle is sprained, what occurs is an overstretching, tearing or rupture of one or more of the ligaments that help keep the ankle bones together. This leads to inflammation, pain, instability and weakness of the muscles that attach to the ankle/foot. The inflammation and swelling are what causes the softball to appear where your ankle bone was, likely accompanied by a splotching of purple and green.
There are 3 grades of ankle sprains; I, II and III which coincide with an increase in severity of symptoms and damage:
· Grade 1: overstretching of one or more ligaments
· Grade 2: partial tear in one or more ligaments
· Grade 3: complete rupture of one or more ligaments
The rehab and treatment of an ankle sprain is dependent upon the grade, as you’d expect. With a grade 1, likely the injured person can bear weight and will be able to tolerate exercises. Those are the ankle rolls, the “I stepped weird” and the “I haven’t worn these heels in a while” sprains. Grades 2 and 3 however, are going to be more painful and require more rest time prior to exercise. The most common of sprains is to the anterior talofibular ligament (ATFL) and frequently occurs when the ankle is in a plantarflexed and inverted position (hello coming down on someone’s foot). Rest alone will likely be enough to make the pain and swelling go away. BUT, the strength, the balance and the stability will not come back without the rehab.
*Regardless of sprain grade* all rehabs (at some point) should include strengthening, mobility, balance work and neural flexibility and we’re not just talking about the ankle itself here. When an ankle sprain occurs, a series of unfortunate events takes place, and Lemony Snickett is not here for comedic relief. One or more ligament(s) is stretched which causes the proprioceptors (the fancy guys that tell our brain what position our ankle is in) to be altered and shut down. The lower leg muscles, most commonly, the peroneals will undergo a rapid overstretch that is commonly followed by tightening and/or weakening. These effects will make it harder for the ankle and lower leg muscles to fire and keep us upright. This also makes it more difficult for the ankle/lower leg to react appropriately to our terrain. This is why the rehab afterwards is so important; retraining and reestablishing the muscles’ stability and proprioception is key to truly getting back to pre-sprain status. It’s so critical to restore the stability of not just the ankle, but the entire leg that was put at a dysfunction from this injury.
Another thing we see from not rehabbing a sprain is the aftereffects up the chain. The ankle/foot is what connects our knee, hip, low back to the ground and this is why it’s not just the ankle we’re looking at. Every time our foot connects to our walking surface, the ground forces are transmitted up the chain of our leg. When a given structure at the bottom (say a tight muscle or stretched ligament) is not properly functioning, something further up the chain must compensate in some way to achieve the desired task. Now imagine that tight muscle or stretched ligament multiplied by 5 or 6 ankle sprains…and add it to continued running, jumping, squatting… you get the idea.
Will this rehab prevent me from ever spraining my ankle again? Probably not. Part of being an athlete is injury risk. BUT the rehab will likely decrease your risk and the severity of another ankle sprain should you have one as well as decrease that cycle of compensations and other injuries.
If I wear a brace for activity will that suffice as my rehab? It will certainly help! But think of that brace as fix-a-flat over a tire hole; It’ll provide support for a while, but ultimately, we have to fix the underlying problems. Rehab and getting stronger is ALWAYS a good idea because it can prevent injuries and it makes you a better athlete.
In conclusion, make sure to get those ankle rolls and sprains checked out. We can help with that 😊
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