If you're a runner, you've probably dealt with an ankle sprain at some time throughout your training...
Maybe you stepped in a pot hole or on your dog's toy, either way it can be frustrating to have an injury holding you back from running.
Most ankle sprains occur when the ankle rolls outward, which is called an inversion injury.
Notice in this image above, as the ankle rolls outward, the ligaments on the outside of the ankle become "overstretched" from too much force and stress.
Some ankle sprains can present with minimal pain, swelling and stiffness while others can result in needing a cast, walking boot or brace for healing. Below is a breakdown of the different grades of ankle sprains and differences between the three.
There are three grades of ankle sprains:
Grade 1
ligament is slightly stretched but results in no tear.
may have minimal/mild pain, swelling or bruising
able to walk with minimal pain
Grade 2
partial tear in ligament
likely to have pain and increased swelling around the ankle
may have difficulty putting weight through the foot while walking
might experience poor stability and balance
Grade 3
complete tear of ligament
severe pain, bruising and swelling
likely unable to walk or put weight in the ankle/foot
Depending on the severity of the ankle sprain, your doctor may order an X-ray to rule out possible fracture in the ankle bones. If a fracture is present, you will likely spend time in a walking boot or cast to allow the fracture to heal. Depending on the type of fracture (open/closed), location and age of the patient, surgery may be warranted to place a titanium rod in the fractured bone.
Majority of ankle sprains can be managed conservatively with physical therapy and medical intervention.
As a physical therapist who works with athletes, I've seen a handful of ankle sprains over the past four years. During an evaluation, I have the athlete perform the following movements: double leg squat, single leg squat, heel raises, lunges and balance drills to see how the ankle is able to handle weight bearing demands. A thorough movement analysis will reveal potential compensations or impairments. Next I will have the athlete on the treatment table and look at their ankle range of motion to take measurements and compare to their non injured side. This will help me see if there is any stiffness that needs to be addressed in the surrounding muscles or joints. Jumping and sport specific demands may be tested in session depending on the severity of injury/symptoms and what the athlete can safely tolerate. Jumping, cutting and running place more stress on the ankle, which is important to assess in the later phase prior to returning to sport.
Treatment will include a combination of stretching, strengthening, stability and balance training before eventually progressing to plyometrics and return to sport program. Everyone heals and recovers at different rates which is why I like to use pain as a guide when looking to progress exercises over time. Typically, I will tell the athlete to try and keep pain below a 3/10 during these exercises and be sure pain resolves with rest, without increased swelling in the ankle.
Most grade 1 ankle sprains can heal over time with compression/icing, walking, stretching and recovery. Grade 2 or 3 ankle sprains will likely need careful medical attention and intervention due to more complexity and severity of symptoms. However, it is always a smart idea to consult your medical provider with these injuries so you can address them early before it turns into a chronic issue.
I always tell people, "motion is lotion" which is way keeping the ankle moving in the early stages can help blood flow circulation, increase muscle activation and reduce stiffness. Our goal is to promote healing and recovery. Balance is important because when the ligaments around the ankle become over stretched or lax they have difficulty performing their job which is to stabilize the bones, this now requires the surrounding muscles to work harder in order to maintain stability, which is why you see some athletes' ankle shaking during single leg balance.
I have experienced all of these ankle sprains throughout my youth playing soccer, basketball and cross country so I understand what you may be going through. Don't wait, take action and get it taken care of so you can return to sport pain free!
Thanks for following along, stay tuned for the next post.
Happy running,
Nick Boles PT, DPT
Running Rehab Specialist
Dry Needling Certified
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