Ligaments are the structures which connect bones and provide stability to joints. A ligament sprain occurs when a ligament becomes overstretched, torn or completely ruptured.

The most common type of ligament sprain in the ankle involves injury to the ligaments on the outside of the ankle and is usually caused by rolling the ankle outwards.

The two most commonly injured ligaments are the Anterior Talofibular Ligament and the Calcaneofibular Ligament.

Signs & Symptoms

  • Sudden pain with outward roll of ankle. May also feel a popping or cracking sensation
  • Localised pain in lateral ankle
  • Swelling and bruising in lateral ankle
  • Pain with bearing weight, walking or running
  • Feeling unstable with bearing weight, walking or running

Diagnosis & Assessment techniques

Diagnosis is primarily based on patient history and physical assessment, but imaging techniques such as diagnostic ultrasound or MRI can also be used to diagnose a ligament sprain.

Prognosis

Recovery depends heavily on the severity of the sprain.

  • Grade 1 sprains (fibres overstretched):
    0-2 weeks
  • Grade 2 sprains (significant number of fibres torn):
    2 weeks – 6 months
  • Grade 3 sprains (complete rupture):
    3 months +

Treatment for a Lateral Ankle Sprain

Initial Treatment

Immediately after an ankle sprain and for the first 48 hours, RICE principles should be followed. This means a combination of Rest, Ice, Compression and Elevation. This is aimed and minimising swelling and further damage to the tissues around the ankle.

Increase Strength

The stability of the ankle joint is a combination of the stability of the ligaments and the strength of the muscles surrounding the joint. In a ligament sprain, the ligaments become overstretched or torn. Because of this, the stability of the joint is more reliant on the muscles around the joint which is why strengthening exercises are a crucial part of the rehabilitation process. Strengthening exercises will commence after the initial treatment phase and some common exercises include calf raises and resisted ankle movements using a theraband.

Increase Proprioception

Proprioception is your ability to sense your body’s position in space. In a healthy ankle, as soon as the ankle begins to roll, signals will be sent to your brain which causes the muscles around the joint to react and protect the ankle. Following an ankle sprain, proprioception is reduced meaning these signals will be delayed or absent. In this instance, the brain can’t sense that the joint is out of position in time to react and protect the joint . Because of this, reduced proprioception increases the risk of reinjury which is why rehabilitation also includes proprioception training. Proprioception training will commence after the initial treatment phase and may include exercises that involve standing on unstable surfaces, such as a foam mat or using a balance board.

Return to Activity

Returning to activity will depend on numerous factors, including the nature of the activity you wish to return to, the severity of the sprain, your age and your body type. In some circumstances, the use of strapping tape or braces may help facilitate a quicker return to activity. However, taping and bracing does not replace proper rehabilitation.