Most people have sprained their ankles to some degree in their life. Be it from sports or from stepping off a curb while walking, it seems to happen to the best of us. In this article we’ll discuss what causes an ankle sprain, what to do about it, and most importantly, how you can keep it from happening again… and again… and again.
What is Chronic Ankle Instability?
Although any one of the many ligaments around your ankle can be strained, the most common site of an ankle sprain is the outer portion of the ankle. These ligaments are put on stretch when you twist your ankle inwards. Most sprained ligaments will heal on their own, and most people who suffer an ankle sprain will be back to their normal activity within 6 weeks. The trouble is, although the ankle may begin to look and act normal to you, after a ligament has been stretched, the small cells that make up the ligament might have been altered in such a way that can lead you to sprain your ankle repeatedly. A stretched ligament will lose proprioception, which is the feedback from the muscles and joints to the brain with regards to their length and position. A healthy ankle will know exactly what angle to be at when you are landing from a jump or stepping down from a curb, while an ankle that has been sprained will not necessarily be in the optimal position during these activities, increasing the risk of repeat ankle sprains. This is what we consider to be chronic ankle instability.
What should you do if you have just sprained your ankle?
You should go to the hospital for an x-ray if:
- You can’t walk 3 or more steps on the affected side;
- Either of the ankle bones (medial or lateral malleolus) is extremely tender to touch.
If you don’t feel you need to go to the hospital, here is how you should manage your fresh ankle sprain:
- Wrap elastic dressing around the ankle to provide minor compression and help with joint swelling;
- Elevate your ankle above your heart for 20-30 min at a time and write the alphabet in the air with your toes. This will help with swelling and with range of movement at the ankle;
- Hold off on any sports or activities other than walking;
- Try to walk as normally as possible without a limp;
- See a qualified physiotherapist for more management strategies specific to your sprain
How to Prevent Chronic Ankle Instability
Once the swelling has gone down and you are able to walk a bit better, try a few of these stretches and exercises to start waking up the cells in the ankle joint again. They will challenge your ankle in a good way to help restore proprioception and increase strength and stability of the small muscles around your ankle and keep your ankle from stiffening up in the future.
These exercises should be performed carefully. Listen to your body and don’t push it too hard too soon. A physiotherapist can help you progress carefully and efficiently through the following exercises:
- Ankle Dorsiflexion Stretch: Stand with your toes 6-10 cm from a wall. Bend your knee trying to reach your knee towards the wall without letting your heel come up off the ground. Hold for 1-2 seconds, then relax. Repeat 10-20 times.
- Single leg balance: Stand on one leg (the sprained ankle side) and try to hold for 30-60 seconds without needing to put your other foot down. Repeat 3-5 times. As you practice this daily, it will get easier. To progress, try closing your eyes or turning your head slowly while standing on one foot.
- Single leg weight shifting: standing on one leg with eyes open, try to shift your centre of gravity forward as far as you can without needing to lift your heel off the ground, then backwards as far as you can without lifting your toes. Then the same thing but side to side. Gently move from one direction to another until your ankle begins to feel fatigued.
- Heel raises: Standing on the edge of a step with your heels hanging off, lower you heels down, then lift them up as high as you can while moving slowly and in a controlled manner. Do about 3 sets of 10 or until your calf or ankle begin to feel fatigued. If this becomes easy, progress to single leg only.
- Sport specific drills: If your goal is to return to a sport, you should recreate small versions of situations your ankle will encounter in your particular sport. For example, you may want to practice small double or single leg hopping, jumping, cutting, running. These should start very small and simple and progress in complexity as your ankle feels stronger and is no longer swollen. A qualified physiotherapist can create a custom exercise plan for you to get you back to your sport.
Progressing safely through these exercises, you should be effectively training your muscles and ligaments to better protect your ankle in the future. It is important to be patient as these progressions can take some time, 1-2 months or longer, to fully recover and safely return to your preferred activity. Consult your physiotherapist if you require any assistance with your exercise progressions or have questions about any phase of the rehabilitation process.