Ankle sprains are the most common foot-ankle sports related injury with 40% of all lateral ankle sprain occurring during sports. A 2016 study by Halabchi et al reported that 58.5% of professional basketball and football athletes had experienced an ankle sprain. Once you have had an ankle sprain, recurrent ankle sprain and chronic ankle instability are common amongst the athletic population (up to 40% recurrence rate).

A lateral ankle sprain occurs when you twist or roll your ankle inward at a high speed. The ligament usually involved is the ATFL (anterior talofibular ligament), and sometimes the CFL (calcaneofibular ligament). Both ligaments attach to the outer bone in your ankle called the fibula.

A study reported the average age of individuals sustaining ankle sprains to be 27 years, with the highest rate of injury occurring in males between 14 and 37 years old. Females had double that estimated incidence rate (13.5 per 1000 exposures) compared to males (6.94 per 1000 exposures).

The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures.
(Up to 40% of ankle sprains go on to develop chronic symptoms, including pain, swelling, instability, and recurrence that persists at least 12 months post-injury)

One of the key reasons to visit your physiotherapist after an ankle injury — Differential Diagnosis

Are all ankle injuries lateral ankle sprains? And should all ankle injuries be managed the same way? The answer is no. Your physiotherapist can help you assess if there are any of the below:

Fractures
Anterior ankle impingement (develops in 1 in 4 people after lateral ankle sprain, could be from a soft tissue injury or post traumatic osteophytes)
Involvement of:

Syndesmosis
Subtalor joint
Midfoot involvement
Injuries to fibularis muscle group
Nerve pathologies

Being confused with what type of ankle injury and not knowing how to properly address it will risk delaying your rehab and prevent you from effectively returning back to work or sports.

Management of Lateral Ankle Sprain

Protection and optimal loading

There is strong evidence for early progressive weightbearing with bracing or taping or potentially an assistive device based on the severity of injury, phase of tissue healing, extent of pain and patient preference.

Early weightbearing is better than no weightbearing in most cases, but it is recognised that for severe cases, a period of immobilisation may be needed. In more severe cases, immobilisation ranging from semi-rigid bracing to below knee casting may be indicated for up to 10 days post injury. If you still can’t bear weight after that, then we may want to need to refer you for further testing for.

Therapeutic exercise

Throughout your rehab, you and your therapist will work out a rehab program designed specifically for your goals. Your program may include protected active range of motion, stretching exercises, neuromuscular training, postural re-education and balance training to assist your back to work or sporting activities.

Manual therapy

Physical agents

Cryotherapy: Ice alone won’t help heal your ankle, but it may help reduce pain. You may use repeated intermittent ice along with an associated exercise program.
NSAIDS: you may use anti-inflammatories to reduce pain and swelling in the first 14 days of lateral ankle sprain.
Ultrasound: There are substantial researched evidence against the usage of ultrasound for acute lateral ankle sprain.

Management of Chronic Ankle Instability

Remember, If you have sustained an ankle sprain, recurrent ankle sprain and ankle instability are common especially in athletic population (up to 40%). Therefore protecting your ankle post lateral ankle sprain is very important for further injury prevention, as listed below:

External support: bracing, taping and/or insoles during sports
Proprioceptive and neuromuscular exercises to improve dynamic postural stability and perceived ankle stability during function in individuals with chronic ankle instability
Manual therapy: graded joint mobilisation and manipulations can improve ankle dorsiflexion range of motion and dynamic balance.
Dry needling of the peroneal muscles can be beneficial

Final Thoughts

Lateral ankle sprain is a common injury that is not always properly addressed in the sporting population resulting in chronic ankle instability and recurring ankle sprains.

Throughout your rehab, you and your physiotherapist will set up realistic return to work/sports timeframes, commence rehab, and adjust management protocols based on reassessment.

Lastly, there is not a “one size fits all” approach for lateral ankle sprain as the variables (e.g age, gender, severity of injury, type of sports, rehab goals, adherence, self-efficacy etc) will collectively affect how rehab is paced and managed.

Hope this helps.

Your friendly neighbourhood Physio,

Tony

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Resources:

Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J., Bleakley, C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies.
Retrieved from: https://pubmed.ncbi.nlm.nih.gov/24105612/
Fraser, J, J., Feger, M, A., Hertel, J. (2016). Midfoot and Forefoot Involvement in Laterla Ankle Sprains and Chronic Ankle Instability. Part 1: Anatomy and Biomechanics
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095951/
Fraser, J, J., Feger, M, A., Hertel, J. (2016). Clinical Commentary on Midfoot and Forefoot Involvement in Lateral Ankle Sprains and Chrnoic Ankle Instability. Part 2: Clinical Considerations
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5159641/
Halabchi, F., Angoorani, H., Mirshahi, M., Shahi, M, H, P., Mansournia, M, A. (2016). The Prevalence of Selected Intrinsic Risk Factors for Ankle Sprain Among Elite Football and Basketball Players.
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098135/
Mugno, A., Constant, D. (2023). Recurrent Ankle Sprain.
Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK560619/#:~:text=Up%20to%2040%25%20of%20ankle,least%2012%20months%20post%2Dinjury
Martin, R, L., Davenport, T, E., Fraser, J, J., Sawdon-Bea, J., Carcia, C, R., Carroll, L, A., Kivlan, B, R., Carreira, D. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision.
Retrieved from: https://www.jospt.org/doi/10.2519/jospt.2021.0302