You Steady, but My Ankle Isn’t – A Physio’s Guide to Ankle Sprains

holding injured sprained ankle

Injured your ankle once and it kept happening intermittently?

Ankle sprain is one of the most common recurrent sports injuries and about 20% of the acute ankle sprain patients develop into chronic ankle instability – this is why grandma says once you injure it, you’ll keep injuring it. Grandma is right, and fortunately, there is a medical explanation for it. First we need to understand some important anatomy of the ankle joint.

The ankle joint, like all joints, gains stability through both its active and passive structures – namely the tendons and ligaments respectively. While ligaments provide local stability of the ankle joint by restricting excessive movement, the tendons provide addition support during activities upon muscle contraction.

When placed under prolonged stress, these bands of fibrous connective tissue will lengthen due to creep effect. An acute sprain can over stretch the ligament or even tear it. The bad news is: a sprained or torn ligaments may heal in such a way that it does not provide the needed stability anymore, thus affecting joint stability directly. Laxity of the ligaments therefore contribute to the recurrence of ankle sprain.

OMG! I just rolled my ankle and I am in pain, what do I do?

The most common ankle injury is an inversion sprain – rolling the ankle inwards. The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are often the victims of the injury.

After an acute injury, you’ll need to first check that you do not have fracture by following one of Ottawa ankle rules: if you cannot put weight and walk more than 4 steps after an injury, there is a chance that there may be a bone injury. Check yourself into a bone doctor clinic.

If you are cleared, then be brave, offload it a little and weight bear as tolerated, you’ll feel better. As a first step for ankle pain treatment, you may wear socks that provide gentle compression for swelling management and support. Also, icing maybe helpful for managing inflammation, swelling and pain in the first three days where the joint may be warm.

Swelling and pain can be managed with contrast bath when the joint no longer show signs of acute inflammation (warm, redness and constant pain). Rubbing over that poor ligament at the early stage is definitely not an option!

During the acute phase of the injury, the active restraints will have to work harder to provide stability – someone’s got to take over the workload of the ligaments since they are unfit for their duty, isn’t it? Use of ankle bracing or taping may be help to provide support in this phase.

In addition to the activity restriction caused by pain, the articulations in the foot and ankle may get stiff due to guarding and lack of movement. So yes, as much as we want the ligaments to heal up, maintaining some mobility is key here. And like everything in life, we need to strike a balance.

Considering our heel takes the first impact in each step we take, it is important that these joints are kept mobile; to dissipate that ground reaction forces and effective with energy transfer down the kinetic chain.

Therefore, performing gentle range of motion exercises may help with easing the stiffness, managing pain and get you moving well sooner. The exercise can be as simple as pointing your toes up and down direction and as frequently as 1 set per hour.

The pain in a minor ankle injury should subside within a week or so. However, no pain doesn’t mean you’ve recovered and able to do all the usual physical activities – remember what granny said? This is even more so for more severe injuries causing tear of the ligament.

Fortunately, not every ligamentous injury requires a surgical repair and most people learn to cope with ankle injuries. Now that the passive stability in the ankle is compromised, our active stabilisers will have to work harder and get stronger to cope with our daily and sporting demands.

Ok, that’s not too difficult, I’ll Google the strengthening exercises and do them myself.

We wished our job as a Physiotherapist was that simple because it does takes more than just strengthening exercises to manage an unstable ankle.

What you need is an individualised exercise programme that incorporates mobility, strength of all components (pure strength, endurance and power), muscle extensibility, coordination, agility and control – because everyone moves differently thus, have different things to work on!

In summary, neuromuscular training is the way to go – the awareness of your body in space and the ability to react to varied conditions.

Most importantly, you need someone with medical knowledge and expertise in exercise to check on your recovery, progress the exercises and guide you towards better performance after your injury. Physiotherapists are movement specialists who are not going to treat you for a just an ankle injury.

Our physiotherapy Singapore specialists will look at your movement patterns and help you to work on other areas that would help to mitigate the risk of future injuries so that you will be more confident with the capabilities of your body and enjoy your activities at the next level.


Disclaimer: we cannot prevent injuries if you make a less than wise decision.

Dr Sharon Wang

Principal Physiotherapist

Dr Sharon Wang, writes from her heart and her personality shines through during her physiotherapy session with her patients. This exercise enthusiast loves a good workout, and you can catch her doing her Yoga to dance routine any day.

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