Ankle sprains are quite common. I bet many of you reading this have had an ankle sprain.

I remember when I sprained my ankle…. I was playing an intense game of racquetball. I jumped up in the air to hit a high ball, really extending my arm upwards. Then I came down, landing on the outside of my ankle as my foot rolled under me. Ouch!

Let’s just say that being a physical therapist now, I certainly would have treated my ankle sprain differently back then.

So, do you always have to go to physical therapy after an ankle sprain?

I would argue yes. Even with a low-grade ankle sprain it is advantageous to go to physical therapy to help get you back on your feet ASAP and minimize any impairment.

If you had a moderate or severe ankle sprain, then physical therapy is certainly recommended to improve recovery and prevent any potential long lasting functional impairments.

A simple ankle sprain left untreated can sometimes turn into recurrent ankle sprains and chronic ankle instability. Next thing you know you can start feeling like you have “weak ankles” and start second guessing doing the activities you love.

So even with a relatively benign ankle sprain it can be a good idea to go to physical therapy. Some research estimates that 29% of ankle sprains in high school students can become recurrent or lead to chronic ankle instability (Holland).

What are some risk factors that predispose people to ankle sprains?

  1. Previous injury: Although conflicting research is available there are several research studies that indicate that people with a history of a lateral ankle sprain are more likely to have another (and we would tend to say this is what we see clinically).

  2. Sex: Females have an increased risk

  3. Age: Every 5 year increase from 15-40 years old was found to increase the odds of sustaining a lateral ankle sprain in elite football and basketball players (Pourgharib)

  4. Those with generalized hypermobility demonstrate an increased risk

  5. Limited or asymmetrical range of motion in both ankles: More specifically, limited motion moving the door upwards (called dorsiflexion)

  6. Decreased hip strength: specifically of hip abductors and hip extensors

  7. Poor performance on single leg clinical tests: This includes single leg balance and squatting tasks

  8. Activity: higher risk with court sports and during the second half of games (soccer, Gaelic football, American football, rugby, futsal) (de Noronha)

What can you do to reduce your risk?

  1. Work on balance training (Bellows). Often times “weak ankles” aren’t actually weak. Meaning they are just as strong as any other set of ankles out there. What they really are is uncoordinated and that’s why they feel weak in certain positions.

    Balance training is the best way to improve ankle coordination. Start with the simple exercises below and then progressively increase the challenge. To do this try to replicate the positions that you would be in when playing your sport. This will have a greater carryover to the activities that you love doing.

  2. Perform unilateral(single leg) functional strength training. Working on single leg squats, lunges, side lunges, and single leg jumps into multiple planes are a great way to improve coordination and control in activities that replicate sport. The key when training is to focus on strict form to ensure that this carries over to the court or field.

  3. Improve your conditioning. There is a reason that more injury occurs in the second half of a game. Because people are tired. And when people get tired and lazy they start to lose good form and coordination. Improving your conditioning will allow you to better tolerate the length of activity and reduce your risk for injury.

  4. For those with increased risk factors as noted above: using taping techniques or ankle bracing when participating in high-risk activities may be of benefit (Leppanen)

So what comes next if you sustain an ankle sprain?

Physical therapy, naturally!

Recommended treatments include:

  1. In the initial stages, progressive weight-bearing is important and bracing and taping may be necessary. Immobilization should only be used in severe cases and for 10 days maximum.

  2. Exercise: A tailored exercise program is important to address each person’s deficits individually. Balance training, neuromuscular re-education, and postural re-education are recommended. (Martin)

  3. Sport and occupation-specific training to help introduce specific movements and postures that you need to do on a regular basis

  4. Hands on treatment: Manual therapy to help reduce pain and increase range of motion

Here are some very simple and basic balance exercises that you can do to help prevent an ankle injury. (Of course, we can make them much harder if necessary depending on your skill level!)

  1. Balance on a single leg while reaching the other leg forwards, sideways and backwards to tap an object outside of your base of support. The further you have to reach, the harder the exercise is

  2. Balance with your feet together eyes closed. Try to hold for 30 seconds. Too easy? Try it again with one foot in front of the other.

  3. Balance on a single leg while doing upper extremity exercises like rows with a tough resistance band

Holland B, Needle AR, Battista RA, West ST, Christiana RW. Physical activity levels among rural adolescents with a history of ankle sprain and chronic ankle instability. PLoS One. 2019;14:e0216243. https://doi.org/10.1371/journal.pone.0216243

Pourgharib Shahi MH, Selk Chaffari M, Mansournia MA, Halabchi F. Risk factors influencing the incidence of ankle sprain among elite football and basketball players: a prospective study. Foot Ankle Sec. 2020:1938640020921251. https://doi.org/10.1177/1938640020921251

de Noronha M, Lay EK, McPhee MR, Mnatzaganian G, Nunes GS. Ankle sprain has higher occurrence during the latter parts of matches: systematic review with meta-analysis. J Sport Rehabil. 2019;28:373-380. http://doi.org/10.1123/jsr.2017-0279

Bellows R, Wong CK. The effect of bracing and balance training on ankle sprain incidence among athletes: a systematic review with meta-analysis. Ing J Sports Phys Ther. 2018;13:379-388

Leppanen M, Aaltonen S, Parkkari J, Heinonen A, Kujala UM. Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2014;44:473-486. https://doi.org/10.1007/s40279-013-0136-8

Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, et al. Ankle stability and movement coordination impairments: lateral ankle ligament sprains revision 2021. J Orthop Sports Phys Ther. 2021;51(4):CPG1-CPG80.http?//doi:10.2519/jospt.2021.0302