Ankle Sprains: More Than Just a Rolled Ankle

11 minutes ago

4 min read

by Osteopath Carien Boshoff

Rolled your ankle stepping off a curb, landed awkwardly, or playing sport?

Ankle sprains are a common musculoskeletal injury. While many improve with appropriate management, an ankle sprain isn’t always something to simply “walk off.” Understanding the injury and gradually restoring movement, strength and confidence can form part of the recovery process and return to usual activities.

What is an ankle sprain?

An ankle sprain occurs when one or more of the ligaments supporting the ankle are stretched or injured. Ligaments are strong bands of connective tissue that connect bones and contribute to joint stability.

The most common type is a lateral ankle sprain, which typically occurs when the foot rolls inwards. This can affect the ligaments on the outside of the ankle, particularly the anterior talofibular ligament (ATFL).

Less commonly, an ankle injury may involve the ligaments on the inside of the ankle or the structures between the tibia and fibula, sometimes referred to as a high ankle sprain or syndesmosis injury.

Common signs and symptoms

Ankle sprains can vary considerably in severity. Depending on the injury, symptoms may include:

• Pain around the ankle

• Swelling

• Bruising

• Tenderness

• Reduced ankle movement

• Pain or difficulty when walking

• A feeling of instability or the ankle “giving way”

The amount of swelling or bruising alone does not necessarily indicate the severity of an injury. Assessment may therefore be appropriate following a significant ankle injury or when symptoms are not improving as expected.

Do all ankle sprains need an X-ray?

No. An X-ray may be appropriate when a fracture is suspected, but not every ankle injury requires imaging.

Healthcare practitioners may use clinical decision-making tools such as the Ottawa Ankle Rules, alongside a clinical assessment, to help determine whether an X-ray may be indicated following an acute ankle injury.

The need for imaging or further medical assessment will depend on factors such as the mechanism of injury, location of tenderness, ability to weight-bear, and other clinical findings.

Should you just rest an ankle sprain?

Complete rest is not always necessary. In the early stages, management may involve protecting the injured area and modifying activities that significantly aggravate symptoms. As tolerated, gradually restoring movement and appropriately loading the ankle may form part of rehabilitation.

Depending on the individual and their goals, rehabilitation may progress through:

Movement → strength → balance → hopping/running → sport or activity-specific tasks

The appropriate progression will depend on factors including the severity of the injury, symptoms, function and the activities you are aiming to return to.

Why is rehabilitation important?

Once the initial pain and swelling settle, it can be tempting to consider the ankle “fixed.” However, an improvement in pain does not necessarily mean that strength, balance, movement and confidence have completely returned.

Following a lateral ankle sprain, some people may experience recurrent sprains or ongoing feelings of instability. Rehabilitation may therefore include exercises targeting ankle movement, strength, balance and proprioception, alongside a gradual return to the demands of everyday activity or sport.

For someone returning to running or sport, later stages of rehabilitation may include activities such as jumping, landing, running and changing direction, depending on the individual and their goals.

Where does osteopathy fit?

An osteopath can assess a musculoskeletal ankle presentation and consider factors such as the mechanism of injury, swelling, tenderness, range of motion, strength, balance and ability to weight bear.

Depending on the individual presentation, management may include:

• Referral for imaging or further medical assessment when indicated

• Hands on treatment where clinically appropriate

• Taping or external support where appropriate

• Education around activity modification and appropriate loading

• Individualised mobility and strengthening exercises

• Balance and proprioception exercises

• Guidance around a gradual return to activity, running or sport

Management should be individualised according to the person's presentation, goals and clinical findings.

When should you seek further assessment?

Consider seeking healthcare assessment if you experience significant pain or swelling following an ankle injury, are unable to comfortably weight bear, have marked bony tenderness, develop numbness or other neurological symptoms, or your symptoms are worsening rather than improving.

Further assessment may also be appropriate if your ankle repeatedly gives way, you experience recurrent sprains, or you are having difficulty returning to your normal activities or sport.

Following significant trauma, or where a fracture or other significant injury is suspected, timely medical assessment is recommended.

Take home message

Ankle sprains are common, but their severity and recovery can vary from person to person. Managing symptoms early is only one part of rehabilitation. Depending on the injury, gradually restoring movement, strength, balance and confidence may form part of returning to everyday activities, running or sport.

If you have recently injured your ankle, or continue to experience symptoms following a previous ankle sprain, an osteopath can assess your individual presentation and discuss appropriate management options. This may include hands-on treatment, individualised rehabilitation exercises and advice around returning to activity. Where appropriate, your osteopath can also discuss whether further assessment or referral to another healthcare professional may be recommended based on your symptoms and clinical findings.

References

Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll, L. A., Kivlan, B. R., & Carreira, D. (2021). Ankle stability and movement coordination impairments: Lateral ankle ligament sprains revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(4), CPG1–CPG80.

Vuurberg, G., Hoorntje, A., Wink, L. M., van der Doelen, B. F. W., van den Bekerom, M. P., Dekker, R., van Dijk, C. N., Krips, R., Loogman, M. C. M., Ridderikhof, M. L., Smithuis, F. F., Stufkens, S. A. S., Verhagen, E. A. L. M., de Bie, R. A., & Kerkhoffs, G. M. M. J. (2018).

Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. British Journal of Sports Medicine, 52(15), 956.

Stiell, I. G., Greenberg, G. H., McKnight, R. D., Nair, R. C., McDowell, I., & Worthington, J.R. (1992). A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Annals of Emergency Medicine, 21(4), 384–390.