Ankle Sprains
March 24, 2016 | by Jeremy D. Johnson MD, MPH, RMSK

Ankle sprains are very common. In fact, approximately 2 million ankle injuries occur in the United States every year. Unfortunately, over 70% of ankle sprains occur among individuals with previous ankle sprains, many of which were not completely rehabilitated.

Ankle sprains are defined as an injury to the ligaments that surround the ankle joint. Ligaments are composed of strong elastic fibers. The severity of the sprain depends on whether or not the ligament was stretched or completely torn. Sprains can be associated with fractures, but these injuries differ in their severity.

    1. When should I see a physician?
      The first reason to see a physician is to be evaluated for a fracture. Signs of a fracture include the inability to bear weight for at least four steps following the injury or if there is tenderness over the bony protrusions of the ankle or foot. In these situations X-rays should be performed to assess for a fracture. Another reason to seek medical advice is to reduce the risk of recurrent or chronic ankle problems. The most important risk factor for ankle sprains is a previous ankle sprain. Therefore, individuals should seek medical guidance and possibly formal rehabilitation to prevent recurrent and chronic ankle issues.
    2. How long does it usually take to get back to my activity?
      Most ankle sprains require two to six weeks to recover, but the length of time required is dependent on the severity of the injury and the activities required of the individual. Treatment involves three phases. Initially controlling inflammation, next regaining full range of motion and strength, and finally regaining the muscular control and endurance required for one’s activities.
    3. What is involved in controlling inflammation? Initially controlling inflammation will decrease pain and swelling, and involves the following:
         • Ice (usually 10 - 20 minutes, with at least 30 minutes in between sessions to avoid frostbite).
         • Compression (using an elastic bandage)
         • Elevation
         • Relative rest
      Depending on the severity of the injury, rest may involve a short term use of crutches or walking boot. However, it is important to note that early mobilization improves time to recovery, long-term stability, and decreases swelling. Therefore, one should begin protected and full weight bearing activities as soon as tolerated. Completing all phases of rehabilitation allows one to confidently return to sport and lessens the likelihood of chronic ankle issues. In particular, rehabilitation should involve exercises to improve strength, balance, and functional rehab exercises to guide one back to sport and exercise.
    4. Does wearing braces help prevent sprains?
      Wearing braces, specifically an air stirrup brace or lace-up support, can be used to aid in early mobilization and to protect against re-injury following return to sport. Unfortunately, braces must be worn during all high-risk activities for at least one year to have this benefit. In addition, braces do not stimulate healing or retrain one’s muscles, ligaments and reflexes to react to the stresses placed on them. To fully recover, one will need to complete all phases of rehabilitation as described above.
    5. How do I know when I am ready to play again?
      In general, once the individual has full movement and strength, in addition to being able to perform all sports-specific activities required without pain, they can return to play. One rule of thumb is the “rule of 20s” where the athlete is able to run 20 yards, cut 20 times, hop on the leg 20 times, and balance with eyes closed for 20 seconds on the affected ankle without problems. However, it’s important to note that the risk of re-injury persists for up to 12 months, even after full rehabilitation. External ankle support and neuromuscular training can reduce this risk and are an important aspect of returning to play safely.

    This article was initially published on the American Medical Society for Sports Medicine.

    The Polyclinic Sports and Performance Medicine Department specializes in foot and ankle sprain treatment. Contact Sports and Performance Medicine at 206-860-5584 to make an appointment or for more information.