The most commonly sprained ligament in the ankle is the Anterior Talofibular Ligament (ATFL), which is also the most commonly sprained ligament in the entire human body. This injury usually occurs during running, jumping, or changing direction when the foot rolls inward and over stretches the ligaments on the outside of the ankle. Some common signs and symptoms of an ankle sprain include: pain with putting weight on the injured foot/ankle, tenderness to touch at the injured site, and/or swelling (usually immediately following the injury). If the injured person is unable to bear weight on the injured ankle/foot for 3 steps in a row, an X-ray may be needed to make sure that there isn’t a fracture in the bones of the ankle or lower leg.
The immediate treatment for a sprained ankle focuses on reducing swelling and allowing the injured tissue to heal. A helpful pneumonic is RICE:
Each component of the RICE pneumonic is designed to help to this end. Resting your ankle is important, because it gives the injured tissue time to heal without stress. When stress is applied to injured tissue, the inflammatory process is perpetuated which slows healing rates. Ice, compression, and elevation are helpful in reducing swelling. Edema, or the fluid that is present in your ankle when swells, contains many different chemical mediators which are important for removing injured tissue. However, when the edema stays in the injured area longer than it was intended to, it continues to break down healthy tissue which slows the healing process. Therefore, while the inflammatory process is important and swelling not inherently detrimental, we want to limit the amount of time an injured limb remains swollen in order to expedite the healing process.
Once the inflammatory phase has passed and pain has reduced to an acceptable level, it is important to restore appropriate ROM, strength, and proprioception to the joint. A good way to assess ROM is to make sure that the injured foot/ankle moves the same amount as the non-injured side in each of the 4 primary directions: plantarflexion (down), dorsiflexion (up), inversion (in toward the middle), and eversion (out to the side). Usually, the most difficulty motion to restore is dorsiflexion. Pictured below (video #1) is a good mobilization to help regain dorsiflexion ROM. 10 repetitions of 10 seconds each is a good dose for this mobilization.
Strengthening exercises are also very helpful in this stage to ensure that the muscles and tendons around the ankle heal adequately. Pictured below (video #2) is a very good strengthening exercise called a heel raise with eccentric lowering. The emphasis here is on raising the body as high as possible onto the toes and then lowering the body slowly and in a controlled manner. This challenges all the muscles in and around the ankle to stabilize the ankle in a functional manner. 3 sets of 10 repetitions each is an appropriate dose for this exercise.
Proprioception is the body’s ability to tell where it is in space which is a big part of what gives us our sense of balance. A good way to train proprioception is by performing some Single Leg Stance, pictured below. To do this simply stand on the injured leg with the non-injured leg in the air and without holding onto anything for support. 3 repetitions of 30 seconds each is a good dose for this exercise.