What is a lateral ankle sprain and how can physiotherapy help?

What is a lateral ankle sprain?

A lateral ankle sprain is an injury affecting the outside of your ankle and is commonly referred to as a ‘rolled ankle’. Essentially, the lateral ligament complex is a set of three ligaments that resist inversion (rolling out) of the ankle joint. These ligaments are called the:

• Anterior talofibular ligament (ATFL)
• Calcaneofibular ligament (CFL)
• Posterior talofibular ligament (PTFL)

Depending on the angle that you roll your ankle, you may damage only one of the ligaments in the lateral complex. Sometimes, you may have a combination injury affecting more than one ligament, or indeed affecting other structures such as muscles, tendons, cartilage or bone. The ATFL, which supports the outside/front of the ankle, is the most commonly injured ligament in the ankle.

Sprain, Strain or Tear? What is the difference?

Technically a sprain is the correct terminology to describe a ligament injury, whereas strain refers to an injury to a muscle or tendon. A tear is often considered a more serious injury than a sprain or a strain, however this is not actually the case. A lateral ligament sprain is actually a tear in the lateral ankle ligaments.

A lateral ankle sprain may occur when your foot is on the ground and it’s not stable enough and rolls over to the side. This causes the ligaments on the outside of your ankle to get stretched beyond their capacity, leading to injury. The severity of a lateral ankle sprain varies depending on how far these ligaments are stretched as well as the speed of the incident.

What does a lateral ankle sprain feel like?

A lateral ankle sprain can feel different for everyone. A key factor impacting the symptoms you may feel is the grade of your lateral ankle sprain.

There are three grades – grade one, grade two, and grade three, progressively becoming more serious. Our physiotherapists recognise that the pain you feel will be unique to you, especially if you are experiencing a combination injury that involves more than one structure.

In saying that, there are some common signs of a lateral ankle sprain for each grade to look out for.

Grade 1 lateral ankle sprain

• Generally minor damage to your lateral ligament complex.
• Pain is common, but no instability.
• Swelling and weakness in your ankle are also common.
• Walking with a limp is common, but people can generally walk without crutches.

Grade 2 lateral ankle sprain

• This often occurs when more force is involved in the injury mechanism, which can lead to a more severe injury.
• Greater disruption of the ligaments.
• More pronounced pain and swelling than grade one.
• Bleeding, bruising and swelling may also occur.
• Some level of instability is a deciding feature of a grade two ligament sprain that we don’t see with a grade one. This is because more of the ligament fibres have been disrupted, causing increased movement and often a feeling of instability at the ankle.

Grade 3 lateral ankle sprain

• A complete disruption of one or more of your lateral ligaments.
• Severe pain, bruising and swelling in comparison to the lower grades.
• Substantial instability and difficulty weight bearing.
• May be part of a combination injury, including multiple ligament tears, muscle or tendon injuries, a cartilage injury in the ankle, or a bony fracture.

How does a lateral ankle sprain occur?

A lateral ankle sprain is a common sporting injury, particularly in football, soccer, basketball, and netball. These contact sports require sports players to remain agile, change direction, and stop and start quickly. These movements can lead to a loss of balance, in addition to a trip or fall, which can lead to a lateral ankle sprain. Sports players are also often challenged or tackled by opponents. This can result in contact, or even stepping on another player’s shoe or boot, with the unstable surface, meaning someone can easily roll their ankle.

Our physiotherapists also see people with a lateral ankle sprain caused by everyday activities. This could be caused by uneven pavement or potholes in the street, or misjudging a step on a set of stairs at home or in the office. City workers may roll their ankle when wearing heels due to the reduced stability caused by a loss of contact with the ground and the elevated position of the heel.

A lateral ankle sprain can also be caused by pre-existing conditions that affect your balance or ability to control your movements. This impacts people who have suffered a stroke or head injury, or those impacted by other neurological conditions such as cerebral palsy (CP) and multiple sclerosis (MS).

Is there anything I can do to help with my ankle pain before an appointment?

First and foremost, it’s important to make an appointment as soon as you can.

The acronym ‘RICE’ should first be deployed:

• Rest. Don’t try and do too much on your injured ankle. Only walk if you are able to. Use crutches if the pain is significant.
• Ice. Wrap a cold pack (from the freezer), or a bag of ice in a light cloth and then apply it to the injured area of your ankle. 20 minutes ice on. 20mins off. Repeating x 3 is a good starting point. Never use heat on an acute/recent ankle sprain as the bruising and swelling will increase. Ice is always the first option for new injuries.
• Compression. Ideally from an elastic bandage. Then, when you make an appointment with Pure Physio, our physiotherapists will create your individualised treatment plan to best support your recovery.
• Elevate. This means keeping your ankle higher than your heart level – lying down with your leg up on some pillows, or the couch is a good option to achieve this.

Once you attend Pure Physio, our team will refine your recovery process.

Why should I see a physiotherapist for a lateral ankle sprain?

Diagnosis is important to understand the time frame for recovery and to plan an appropriate rehabilitation program. A professional consultation also enables a tailored approach to fit in with your lifestyle and activities. The risk of recurrent injuries can also be reduced by rehabilitating your lateral ankle sprain.

The initial appointment is designed to equip you with the tools and exercises to empower you to stay as mobile as possible throughout your recovery process. Our physiotherapists will consider your clinical history, lifestyle and sporting activities, and perform a series of assessments in-clinic.

As part of our analysis process, you may also be referred to imaging, to ensure we have a detailed perspective on your presentation. There are four key types of imaging we may use for a lateral ankle sprain:

• X-rays to look for fractures or damage to bones.
• Ultrasound to look at your tendons and ligaments.
• CT to better assess for any bony abnormalities. If there is potential for intra articular (within the joint) damage, or a fine, bony fracture is a concern, then a CT scan may provide the additional detail required to completely diagnose the injury.
• MRI (the gold standard of imaging) to examine the inside of your ankle joint, including bones, cartilage and soft tissues (tendons and ligaments). This is a ‘catch all’ scan.

Our physiotherapists will also provide you with a detailed understanding of how your lateral ankle injury will continue to improve in the coming days and weeks. From here, our physiotherapists will assess your progress and focus further appointments to best meet your needs and help you return to your normal routine.

How long does it take for a lateral ankle sprain to heal?

Recovery timeframes vary from person to person. Our physiotherapists often see combination injuries, which can be part of the reason why the healing process looks different for everyone.

As mentioned, there are three grades of a ligament sprain, progressively becoming more severe, which will impact your recovery journey.

The timeframes outlined below indicate how a lateral ankle sprain exponentially increases in recovery time, and should only be used as a reference point. We recommend making an appointment with our team for a thorough assessment of your injury and a rehabilitation exercise program tailored to your unique presentation.

• Grade 1 – typically between 1-3 weeks recovery.
• Grade 2 – usually 3-6 weeks recovery.
• Grade 3 – the recovery period is very dependent on the outcome you’re aiming for. For example: are you returning to sport? Or looking to be able to walk 5,000 steps per day? Overall a significantly longer recovery period is required for this group (up to 12 weeks). This can increase further if surgery is required to stabilise (reconstruct) the damaged ankle ligaments.

How do you treat a lateral ankle sprain?

Our physiotherapists are here to help you return to your everyday routine, work, and sporting activities as soon as possible.

There are a range of different support devices designed to support your recovery, which will be tailored to your unique injury.

Some common support devices include:

• Small heel raises. These can make walking easier in the early phase if your ankle is stiff and swollen.
• Crutches. One or two to assist with walking.
• Moon boot to assist with walking.
• Ankle strap or tape. Not recommended when there is a lot of swelling.
• Ankle brace for support.

Your treatment will be tailored to your individual goals, lifestyle, medical history and the severity and degree of your lateral ankle sprain. As mentioned, enlisting whatever tools you need to support you prior to your initial appointment is a great first step.

However, it’s important to ensure these support devices are meeting your unique needs. This is something our experienced physiotherapists will determine when you present your injury in clinic.

Ultimately, our aim is to keep you as active as possible throughout your recovery period, while minimising pain where possible. We’re here to help you return to your daily routine, favourite sport, or keep up with your kids, and to accelerate your recovery timeframe.

Following a lateral ankle sprain, other areas of your body can also be impacted. This can include a loss of strength in your calves, quadriceps, or hamstrings; or strain to your back, hip, or pelvis. These areas can be impacted as they are often neglected due to modified activity as your lateral ankle sprain recovers.

Likewise, you may find yourself unintentionally using these muscles to overcompensate for your injured ankle when walking to avoid weight bearing due the pain and discomfort you are experiencing.

Our team will incorporate a range of exercises that address other areas in your body that may be impacted. Sometimes, your exercise program will begin with targeting these areas due to serious pain in your ankle. As your pain reduces, our team will begin to introduce ankle-specific, and sometimes calf-specific exercises to your program.

This holistic and multi-purpose approach is designed to empower you to maintain movement in the early stages of your recovery, strengthen the affected areas, and help get you back on your feet sooner.

How to prevent a lateral ankle sprain?

Our team is here to guide and support you through your recovery journey and help prevent injuries from recurring.

Exercise is a crucial part of your treatment and rehabilitation process. One common example of this is ‘return-to-sport’ testing. This involves a series of exercises to determine whether it’s safe for you to return to sport at a particular stage of your recovery. The data gathered from these tests also indicates whether there is a significant risk of reinjury if you return to sport early.

It’s also important to understand that every time you injure your ankle, you won’t necessarily get another grade one lateral ankle sprain. In fact, the risk of the severity increases if you continue to repeat the movements which caused your initial ankle sprain without ample treatment and rehabilitation.

As part of your rehabilitation program, you will also receive a targeted at-home exercise program to empower you to recover from your injury better than before.

Some ways you can minimise risk of a lateral ankle sprain include:

Proprioception retraining.

These exercises are focused on rebuilding your balance and agility following your injury. Sport-specific drills are also commonly incorporated into these retraining programs. Ultimately, proprioception retraining helps you regain awareness of where your foot is in relation to the rest of your body. This ensures you’re ready to return to your sporting activities and other movements—pain-free—and minimises your chance of reinjury.

Bracing.

This may seem like a simple one, but it’s important to do it right. A simple bandage wrap is not likely to reduce your risk of reinjury. Instead, wearing an ankle brace that includes some type of structural support can be a big help in supporting your ankle as it heals from a lateral ankle sprain injury and when you first return to sport.

Taping.

This is similar to bracing. Essentially, the tape supports your ankle and reduces the ability for excessive movements at the ankle joint that may otherwise strain your lateral ligaments or tendon. This makes taping a great tool for preventing reinjury of a lateral ankle sprain, although the key limitation is the requirement of a trained person to apply the tape in the correct fashion.

Misconceptions about a lateral ankle sprain.

There’s a common misconception that if you have a fractured ankle, you won’t be able to walk on it. Some people use this as an at-home test to self-diagnose if they have a serious ankle injury. Put simply, this isn’t true and won’t tell you much about the nature of your injury.

There are a range of different factors that can cause significant pain and dysfunction to the point that people can’t walk – and it’s not always a fracture. It’s best to make an appointment with one of our experienced physiotherapists to get assessed as soon as you can. This will ensure you receive a professional diagnosis of your lateral ankle sprain, and receive the appropriate support and treatment you need to get back on your feet.

Looking for support in your recovery from a lateral ankle sprain?

Book an appointment today.

 

About the Author

Andrew Sargent — Director & Titled Sports Physiotherapist.

Andrew is currently rehabilitating following shoulder surgery. He is expecting to return to his clinical role from June 2024.

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