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Ligaments are tough bands of tissue which connect the bones of the leg to the foot, holding together the ankle joint and providing support. They have specific boundaries which they can stretch to and when you go beyond this, this can result in a tear.
The most common injury occurs to the ligaments on the outside of the ankle, known as the lateral ligament complex. You can also injure the ligaments on the inside of your ankle (medial ligament complex) and very occasionally above your ankle joint in between your tibia and fibula (syndesmosis). Which ligament is affected usually depends on which direction your foot is forced into during the initial injury.
An ankle sprain often occurs when the foot suddenly twists, forcing the ankle joint out of its normal position. Most commonly you over stretch your lateral ligament complex, when your foot and ankle is forcibly turned inwards, this movement is called inversion.
Anyone at any age can have an ankle sprain. It can happen in various ways, such as; participating in sport, walking on uneven surfaces or wearing inappropriate footwear. Unfortunately when you sprain your ankle once, it can increase the chances of this happening again. This is why it’s important to improve the strength of the muscles around the ankle and work on balance exercises.
A thorough examination by your GP or physiotherapist is usually sufficient to diagnose an ankle sprain. You may have heard an audible snap or crack as your foot turned inwards or outwards and symptoms may include:
Ankle sprains will usually settle down within 6 to 12 weeks; the length of time for recovery can vary depending on the severity of the injury. More severe ankle sprains can affect other structures in your ankle such as bones, muscles and cartilage. If an injury occurs to these structures too it can slow down the recovery and can cause quite persistent pain and swelling although usually with time this will settle down. If your ankle doesn’t settle down in the time you would expect or you are having problems getting back to activities at work or you chosen sport then contact your physiotherapist.
The initial focus of physiotherapy is to reduce the swelling and gradually start to increase your range of movement. This could involve the use of crutches to offload the ankle and using the principles of RICE (rest, ice, compression and elevation). If you went to A and E and sustained a severe ankle sprain you may have been provided with a boot to provide some protection and support to the ankle. Listen to the advice you have been given in A and E but usually you be weaning yourself out of the boot after 1-2 weeks.
Below are some early range of movement exercises you can start as soon you feel able. You may experience some discomfort whilst performing some of the exercises and this may persist for some time after finishing them. How much and how long the pain lasts for is something you will discuss with your physiotherapist, but usually if the pain and the length of the time the pain lasts for is acceptable to you, then it’s fine.
The pain you may experience after the exercises does not mean you are damaging anything. You can progress yourself gradually through the exercises as your pain, technique and swelling allows. This means if you have good technique and you don’t experience any severe reactions like unacceptable pain and swelling after the exercises then you can progress yourself onto the next video.
Below are some intermediate strengthening exercises for the legs. Although pain and swelling will eventually settle down your injured ankle may not be as stable as your unaffected ankle. You may also notice that the whole leg feels weaker so below are some exercises which will help strengthen the ankle, knee and hip. Research evidence shows that by strengthening the muscles in the leg this should improve their reaction times to switch on which could ultimately improve your balance (proprioception). This will hopefully reduce any further injuries in the future.
Below are some later stage impact exercise videos designed to help with the later stages of rehabilitation. When getting back to sport it is important to get the ankle used to the individual demands of your chosen activity prior to returning. The aim of these exercises is to continue building your confidence by testing your balance through jumping and hopping drills. If you are unsure if you are ready to start these exercises or return to sport you can discuss this with your physiotherapist.