How to Heal an Ankle Sprain
If death and taxes are the top two on the list of events likely to happen to all of us, sprained ankles are a close third, at least among those who participate in sports.
The ankle is the most frequently injured part of the body among athletes. The severity of the injury ranges from one that allows the person to return to normal activity in a few days to an injury that keeps a person out of action for weeks at a time, and those who have had a sprained ankle are the ones most likely to suffer the same injury again and again and again.
How It Happens
A sprained ankle is a stretch, tear, or rupture of at least one of the ligaments that hold the bones of the ankle joint together. The tears may be microscopic in size or so large that they represent a complete disruption of the fibers. One of the ligaments that wraps around the outside of the ankle is the weakest of the ankle ligaments and is the one most frequently injured. It is possible that all three ligaments supporting the ankle, from front to back, may be sprained. The vulnerability of the ankle as a structure causes the foot to move like a badly mounted wheel.
The most common cause of a lateral (outside) sprained ankle is when an athlete rolls over on the outside of the ankle, forcing it to move beyond its normal range of motion. Common scenarios include trying to change directions when the pivot foot is in a fixed position, landing on an uneven surface, and being out of control when landing after a jump. All three situations often occur in basketball.
“Interestingly enough,” says Steve Smith, a physical therapist at Athletes’ Performance in Florida, “some research has shown a correlation between weak gluteals (buttocks) and the incidence of ankle sprains, possibly due to a lack of stability and control.”
Ankle Sprain Versus High Ankle Sprain
The dreaded high ankle sprain differs from a standard ankle sprain according to the ligaments that are involved. In a standard ankle sprain, the ligaments that connect the bones in the lower leg to the foot and ankle bones are injured. But in a high ankle sprain, the ligaments that connect the two lower leg bones together are injured, explains M. Ramin Modabber, MD, Chief of Orthopaedic Surgery, Saint John’s Health Center; President, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California.
Naturally, the location is higher up the leg. Modabber says high ankle sprains are usually associated with a higher degree of injury, and require a longer time to recover and return to sport. That's because the forces on these ligaments are greater and they need to be healed before athletes can tolerate running, jumping, and cutting—another reason for the longer time to return to sport, says Modabber. Standard ankle sprains allow return to sport in days to weeks, while high ankle sprains can be weeks to months, he says.
By the Numbers
Percentage of all sports injuries that are sprained ankles.
Percentage of those who sustain multiple sprained ankles over an extended period of time.
Percentage of ankle sprains that happen when the foot rolls over to the outside of the ankle.
Who’s At Risk
Basketball players are at the highest risk, with sprained ankles accounting for more than 40 percent of all basketball-related injuries. They are also the most common injury, though at a lower rate, among volleyball, soccer, tennis, football players and others who participate in running and jumping.
The amount of pain depends on how much the ligament has been stretched or torn. Physicians categorize ankle sprains according to the severity or degree of tissue damage.
- Grade 1: Mild pain, tenderness, localized swelling, but no instability; the person can walk, but is limited when trying to jog or jump; the ligament is stretched but not torn, and there is some damage to the ligament fibers
- Grade 2: A tearing or popping sound of the ligament as the ankle rolls to the side; significant bleeding and bruising (sometimes developing 3-4 days after the injury); moderate tenderness and swelling; decreased range of motion; the ligament is partially torn and the ankle is abnormally loose; difficulty in walking
- Grade 3: Extreme pain, swelling and tenderness; major instability, difficulty in walking, feeling of the ankle giving out; the ligament is completely torn
- Rest 24-48 hours to prevent further damage
- Apply ice packs for 15-20 minutes, 3-4 times a day for the first 24-72 hours, but don’t apply ice directly to the skin
- Use an elastic bandage or wrap to limit swelling, from the base of the toes to the top of the calf muscle, for the first 24-36 hours
- Protect the ankle with an air brace or other ankle support device
- Elevate the leg/ankle higher than the trunk to limit swelling 2-3 hours during the day; use pillows at the foot of the mattress or elevate the end of the bed with securely placed books or blocks of wood
- Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation
Recovery time depends on the grade of the injury and ranges from a few days to six weeks or longer. Continue your rehabilitation program until all symptoms have subsided, you have full strength in the injured ankle (when compared to the uninjured ankle), and you have full range of motion with pain. Go through each movement used in your sport (without pain) before you return to action.
Incorporate these prehab exercises into your comeback routine:
- Closed Chain Ankle Dorsiflexion
Note: make sure that your arch doesn’t flatten out, as this is a compensation for a lack of true ankle mobility
- Foam Roll or Massage Stick
What it works: the calf muscles, peroneals, buttocks, tensor fascia lata, and iliotibial band
- Sidelying Clamshells and Side-lying Hip Abduction w/ Slight External Rotation
Note: start with back against the wall to aid trunk stability
- Deep Squat
Why: to integrate the work you did in the preceding activities back into multi-joint movements
How to Avoid It
- Wear high top shoes that protect the ankle during sports activities.
- Wear shoes that provide lateral (side-to-side) support.
- Wear a brace or tape your ankle for added protection and support.
- Do not increase training intensity, duration, or frequency more than 10 percent a week.
Incorporate these exercises into your dynamic warm-up, or movement prep, routine:
- Mini Band Internal/External Rotation
- MIni Band Walking - Forward, Bent Knee
- Mini Band Walking - Lateral, Bent Knee
- Mini Band Walking - Linear, Straight Leg
- Mini Band Walking - Lateral, Straight Leg
- Knee Hug - In Place
- Leg Cradle
- Inverted Hamstring Stretch
- Marching - Bent Knee
- Marching - Straight Leg
- Skipping - Forward
- Skipping - Lateral
Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.
- M. Ramin Modabber, MD, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California
- Steve Smith, PT, DPT, SCS, CSCS, Manager, Performance Physical Therapy Services, Athletes’ Performance in Florida
- Penn State Sports Medicine Newsletter
- American Academy of Orthopaedic Surgeons
- University of Michigan Health System