Ankle sprains account for approximately 14% of all sports related injuries, with 80% of these being caused by inversion strains to the ankle (rolling your ankle) leading to damage to the lateral (outside) ligaments of your ankle. The lateral ankle ligament complex is made up of three ligaments; the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). These three structures are more prone to injury compared to the medial ligaments of the ankle, as those on the inside of the ankle are relatively stronger and more widespread.
They can be classified into three grades dependent on the amount of damage sustained during the injury.
Grade 1 - Mild stretching of the ligament complex with no joint instability
Grade 2 – Partial rupture of ligament complex with no joint instability but mild joint laxity
Grade 3 – Complete rupture of ligament complex with instability of the joint and excessive laxity.
Epidemiology (who is affected)
Athletes and non-athletes who are physically active. Sports such as Football, Rugby, Tennis and Cricket carry increased risk of ankle sprains due to them being activities that require quick changes in direction.
Other risk factors include:
A lack of strength and flexibility potentially as a result from a lack of regular exercise
Poor technique during sport leading to increased strain and pressure at the ankle
Incorrect or inappropriate footwear e.g. boots with worn studs when playing rugby or football, trainers with poor grip…
An inadequate warm up or cool down (see our post 'Why do I keep getting injured?' for further information)
Muscle fatigue leading to poor control and stability of the ankle joint
Playing sport (or even just walking) on an uneven or poor surface e.g. cobbled streets, uneven paving, a boggy or wet pitch or court…
Aetiology (the cause)
The cause of lateral ankle ligament sprains is more often than not, an inversion strain (more commonly known as rolling your ankle) causing the ligaments to stretch and damage. A lateral ankle sprain is also more likely to occur when your foot is plantar flexed (on tip toes), leading to the ATFL being the most commonly injured ligament followed by the CFL. The PTFL is much less frequently injured and is more associated with a greater deal of trauma to the foot and ankle.
Management and rehabilitation
Initial management includes RICE (Rest, Ice, Compression and Elevation) protocol for the first 48-72 hours. During this period, weight bearing on the injured ankle should be slowly increased to help reduce the swelling, increase ankle motion and enhance rehabilitation1. The amount of weight bearing depends on the grade of ligament sprain, with more severe grades maybe requiring assistance to start with (i.e. crutches, strapping, braces). A normal ‘heel-toe’ gait should be encouraged during this time.
Other aims for the rehabilitation include:
Restoring a full range of motion
Gradual increased weight bearing as pain allows
Passive treatment (as can be provided by Osteopaths, Physiotherapists etc)
Active strengthening exercises that increase in resistance as pain allows (movements should include plantarflexion, dorsiflexion, inversion and eversion)
Weight bearing exercises as pain permits (e.g. wobble board exercises)
Proprioception/Balance exercises such as single leg standing, that gradually progress in difficulty by making balancing harder (flat ground to trampoline to functional movements such as hopping or jumping)
‘Prehabilitation’ and prevention
Rehabilitation exercises should be continued once the pain and injury has resolved to reduce the risk of re-injury.
Maintenance of active and passive mobilisation exercises to keep a full range of motion (done by yourself and with the help of manual therapists such as an Osteopath or physiotherapist)
Strengthening exercises including functional movements such as hopping, leaping and bounding
Other tips to reduce the risk of re-injury include ensuring you have an adequate warm up and cool down when exercising. Also, make sure you have appropriate equipment (especially footwear).
The use of strapping and taping during sport can also help reduce the risk of re-injury but in no way should be a replacement for a good rehabilitation/prehab programme.
Please note the information in this article should in no way be used to replace seeking advice from a health professional. If you are unsure about your injury, or need help or advice about recovering from an injury (from sport or otherwise) then it is always best to seek help.
1. Brukner, P., Khan, K., et al. (2012) Brukner & Khan’s Clinical Sports Medicine. 4th Ed. North Ryde, Australia: McGraw-Hill Education
2. Fong, DT., Chan, YY., Mok, KM., et al. Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol. 2009;1;14