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Ankle Sprains – Don't let an acute issue become a chronic problem!

Updated: Aug 14, 2023

The symptoms often associated with an acute ankle sprain typically will gradually improve. However, the evidence seems to point to a first ankle sprain often being the gateway to issues down the road. Check out our post here to see how you can recover more quickly and how to mitigate issues down the road.


A rolled ankle. Twisted ankle. Ankle sprain. We've all heard at least one of these names for this common ligamentous injury thrown around. You can hardly watch ESPN without hearing about someone sustaining an ankle sprain on any given week. They are injuries that don't discriminate by sport – we've seen gymnasts and dancers, soccer and basketball players, and more (heck, I've even seen a bowler) – but they can happen to non-athletes as well.


Fortunately, most ankle sprain injuries will see their symptoms gradually improve – the swelling subsides, the pain calms down, and the stiffness slowly loosens up. But what if there was something you could do to see your pain and mobility improve more quickly? And what if there were things you could do to try to reduce the risk of re-injury down the road?


Treating Acute Ankle Sprains – Comprehensive Treatment for Ultimate Success

How Good Early Treatment of Ankle Sprains Can Reduce Injury Risks Later

How Do I Know When to Return to Sports?

 

Best Practice in Treating Ankle Sprains

Historically, people think ice and rest are best. Unfortunately, this is pretty far from the truth. People usually are more acutely aware of those primary symptoms – pain, swelling, and stiffness – that follow ankle sprains. With specialty training in manual therapy, we're equipped to perform mobilization and manipulation treatments of the foot and ankle that have been shown to help with faster improvements in pain, stiffness, and swelling. That's the good news. On the flip side, we often see a few common consequences associated with ankle sprains when comprehensive rehab hasn't been completed:


-Balance deficits

-Strength and power deficits

-Coordination and stability deficits


The even better news? We're equipped to assess for these impairments that often accompany ankle sprains and can provide a structured rehab program to help you get as close to your normal as possible.



Reducing Risk of Injury or Re-Injury After an Ankle Sprain

Many people see their acute symptoms – the swelling, the pain, the stiffness – gradually improve. Many younger athletes with less severe sprains often can keep playing with minor symptoms. Unfortunately, a history of one ankle sprain appears to be a big risk factor for enduring another ankle sprain. A study in the early 90's examined military recruits to see what factors seemed to be associated with suffering an ankle sprain during basic training. One of the two or three factors that came out as statistically relevant? Having had a history of an ankle sprain previously. We've seen this pop up at other times in the research regarding ankle sprains. We've even seen a group of people that fall into the diagnostic category of chronic ankle

instability, wherein these individuals tend to roll or sprain their ankle(s) repetitively. With chronic ankle instability (CAI), we've seen associations with other injuries and with movement patterns associated with other injuries as well, from knee pain to ACL injuries and beyond. We fairly frequently see people into their late 20s and 30s that estimate 5+ ankle sprains and now are dealing with significant limitations with their balance and coordination, especially if they are actively involved in sports.




Structured rehab for ankle sprains – even the first-time, acute ones – should likely include a mix of manual therapy (i.e., the hands-on interventions to help improve mobility and pain), progressive strength training, and progressive balance and coordination tasks. The specifics may look different from person to person. For example, we likely are going to perform some combination of mobilization/manipulation treatments for a soccer player and a basketball player. However, the late-stage rehab is likely going to incorporate some different elements. With the basketball

player, we're likely going to explore jumping and landing technique, especially in a lateral plane. This likely will progress to include overhead visual target tracking and landing on uneven surfaces, because no basketball player ever is simply standing on foam and looking straight ahead. With a soccer player, we likely will include some jump-landing tasks as well (because soccer players will have to jump at some point, too), but the requirements of the foot and ankle are different. If we're seeing a right winger with a left ankle sprain, it's important that they can quickly decelerate from a sprint, plant their injured foot, and deliver a powerful cross with their uninjured foot. Cookie-cutter treatment can help with some impairments, but getting specific and incorporating sport-specific elements into training and rehab can offer a means to see how an athlete is doing (i.e., how close they are to getting back to full participation) as well as to address their specific needs.



How Do I Know When to Return to Sports After an Ankle Sprain?

Unfortunately, there is no one golden rule for ankle sprains. Often you may hear people throw around a general timeline. However, safe return to full activity must be considered from multiple aspects:


-Symptom tolerance

-Performance

-Psychological readiness


In recent years, we have seen more and more a link between psychological readiness and injury rates after enduring a first injury. What this might look like – you try to get back to a light practice but are tentative or apprehensive with basic tasks (e.g., a basketball player stopping for a short shot instead of going through a normal layup drill, an outfielder stopping short of a fly ball that they normally would have run down without thinking twice, etc.). A candid discussion about how an athlete is feeling can be insightful, and working to address their concerns can help to reduce some of these attentional barriers that can not only interfere with performance but ultimately lead to unusual movements that may contribute to additional injury.


We often will oversee partial return to practice even when an athlete is experiencing mild symptoms. It is often safe after symptoms begin to subside to get athletes back to some degree of participation. What becomes even more important is to see how symptoms respond. If an athlete can get back to basic agility and conditioning drills without significant or lingering pain, this often is to the athlete's advantage. Again, you can do heel raises and balance on a foam pad all day, but the best way to train for a task is to train for a task.


With performance testing, we routinely utilize a battery of well-defined tests. Again, there is no gold-standard test. However, there are several performance tests that have been studied that can help us to understand if an athlete is at a slightly higher risk of sustaining another injury. What we have seen – some athletes recover more quickly than others. Instead of relying on somewhat arbitrary timelines, we believe firmly in testing performance capacity, as well as psychological readiness and symptom tolerance and response, to help guide athletes back to the field or court instead of just waiting four to six weeks and going from 0 to 100.


Want to learn more about how we work with athletes and athletic injuries? Check out our Sports and Performance Medicine page!


References:

Whitman JM, et al. Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. J Orthop Sports Phys Ther. 2009;39(3):188-200.

Loudon JK, et al. The efficacy of manual joint mobilisation/manipulation in treatment of lateral ankle sprains: A systematic review. Br J Sports Med. 2014;48:365-370.

Nguyen AP, et al. Effects of Mulligan mobilization with movement in subacute lateral ankle sprains: A pragmatic randomized trial. J Manual Manipulative Ther. 2021;29(6):341-352.

Milgrom C, et al. Risk factors for lateral ankle sprain: A prospective study among military recruits. Foot & Ankle. 1991;12(1):26-30.

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