What is a Sprained Ankle? The Symptoms & Treatment Options

According to the Australian Institute of Health and Welfare,[1] sprained ankles are the most common ankle injury that present to the hospital. Approximately 3,000 Australians with sprained ankles are hospitalised. Based on the incidence rate in the USA,[2] around 166,000 Australians will sprain their ankle every year.

Ankle sprains generally occur after suddenly rolling or jolting the ankle. Examples include landing awkwardly after jumping or tripping. Sprained ankles can range from ligaments being overstretched to completely tearing. Pain, swelling and bruising often occur after spraining an ankle.

What is a Sprained Ankle?

An ankle sprain is an injury that describes a tear of the ligaments that surrounds the ankle. Ligaments of the ankle provide stability between neighbouring bones. Tears of these ligaments are graded between 1 to 3 based on the severity of the injury.

What are the symptoms of an ankle sprain?

The most common symptoms of a sprained ankle are swelling, pain and limited range of motion. People may also experience a feeling of instability, tenderness or bruising and may sometimes develop a limp.

Common symptoms of a sprained ankle

• Swelling around the ankle joint

• Pain

• Tenderness

• Bruising

• Instability of the ankle

• Difficulty moving the ankle or weight-bearing

What causes a sprained ankle?

Ankle sprains are usually caused by a rapid twisting movement with your foot planted. For example, when playing soccer, running or landing awkwardly. Usually, the ankle will roll outwards as the foot turns inward, causing the ligaments on the outside of the ankle to tear.

Common causes of ankle sprain

• Awkward landing of the foot after jumping

• Fall on a twisted ankle

• Walking on uneven surfaces

• Prior ankle sprain

• Weak leg muscles

• Improper shoes

• High impact sports like basketball or tennis

How is a sprained ankle diagnosed?

Sprained ankles can be painful and may impact your mobility. Additionally, due to muscle weakness and imbalance, ankle sprains tend to happen repeatedly.

There are several options available when it comes to diagnosing your ankle pain as a sprained ankle. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are highly specialised medical professionals that deal with joint and ligament injuries like an ankle sprain. A physiotherapy assessment is simple yet comprehensive.

Like visiting a GP, your assessment will start with your physiotherapist asking you vital questions about your health. This is referred to as consultation. Your consultation will last for about 30 to 60 minutes. Take this time to discuss relevant issues relating to your ankle.

After establishing the background of your condition, your physiotherapist will perform specific physical tests to determine the best possible cause of your problem and rule out other conditions.

Following your initial assessment, your physiotherapist will provide you with a tailored treatment plan based on your condition.

From here, your physiotherapist will give you the details of your treatment program; this will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and to prevent worsening of the condition

• Timeline for your recovery.

Grade of ankle sprains

The severity of an ankle sprain is classified by a universal grading system from grade 1 to grade 3. To ensure an accurate diagnosis, the grading of an ankle sprain must be conducted by a medical professional, such as a doctor or a physiotherapist via manual assessment and/or ultrasound.

Grade 1 Ankle Sprain

Grade 1 sprains typically describe a mild injury where the ligaments have primarily been overstretched with a 5% loss in function. Individuals will notice some swelling, tightness, pain and loss of flexibility in the affected ankle.[3]

Grade 2 Ankle Sprain

Grade 2 ankle sprains tend to describe a moderate injury where some ligaments are torn with a 5-50% loss in function. Those diagnosed with grade 2 sprains will notice more severe symptoms compared to grade 1 sprains. Loss of flexibility, additional pain, and bruising are often seen in these types of injuries.

Grade 3 Ankle Sprain

Grade 3 sprains are the most severe types of injuries which lead to a complete tear or rupture of the ankle ligaments. More than 50% off function will be lost when this occurs. Severe pain, swelling, bruising and tenderness over the area can be felt when grade 3 sprains arise.

How is a sprained ankle treated?

Sprained ankles can be painful and may affect your mobility. This condition tends to be recurrent if muscle weakness and balance are not restored to normal. In Australia, the likelihood of recurrence of an ankle sprain is as high as 61%.[4]

There are several options when it comes to treating a sprained ankle. One of the more common, and the treatment option referred by Australian GPs the most frequently is physiotherapy.

A rolled ankle is an injury that physiotherapists come across regularly, and the process of treating it is straightforward. Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

A combination of manual therapy, modalities, and specific movement exercises will be given to you by your physiotherapist. Physiotherapists are experts in dealing with pain and musculoskeletal conditions.

Depending on the severity of your sprained ankle, a physiotherapist may provide you with a combination of the following types of treatments:

• Therapeutic Exercises - Designed to help strengthen the ankle and help prevent further injury.

• Balance and Proprioception Training - These exercises are specific to ankle sprains and are designed to reduce the chance of recurrence.

• Manual Therapy - Hands-on therapy to help increase range of motion in the ankle.

• Stretching Exercises - Aimed at increasing flexibility and movement.

• Joint Mobilisation - A manual technique that can improve movement in the ankle joint.

• Dry Needling - A specific technique that can help reduce excessive swelling and pain.

• Taping - Taping can be helpful in managing swelling and reducing the likelihood of re-injury in the early stages of recovery.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.

Next step - Creating a treatment plan unique for you

Following your initial appointment, your physiotherapist will craft a tailored treatment plan that will highlight the course of action required, including what exercises you need to do at home. They will also provide you with a timeline for how long it should take for a full recovery.

Self-care for an ankle sprain

If you think you have a sprained ankle, here are the best things you can do and avoid.

Things to do:

• Rest

Listen to your body and rest. Watch for signs of inflammation and symptoms of a sprained ankle. Seek professional help and advice from your physiotherapist before engaging again in high-intensity activities.

• Ice

Apply a cold compress for about 10 to 15 minutes and repeat every 2 to 3 hours. This will reduce the amount of swelling and pain in your ankle.

• Compression

Compress the ankle joint with an elastic bandage to control the swelling and limit the mobility of the ankle joint, preventing further damage to the inflamed ligaments. Do not wrap the ankles too tightly. Instead, make sure that there is still proper circulation within the area.

• Elevation

Elevate your ankle joint above the level of your heart, especially when you sleep at night. Elevation between 30 to 45 degrees is ideal for helping manage the swelling.

• Use an assistive device in the meantime

Assistive devices such as crutches can help you decrease the load on your foot and assist you in walking, preventing further damage to your ankle ligaments during the initial stage of the injury.

Things to avoid:

• Avoid activities that worsen the pain

Take rest and consult a physiotherapist as soon as possible. Avoid weight-bearing activities and placing heavy loads on your ankles as much as possible.

Do I need a specialist or surgery?

In severe cases such as a complete tear of the ankle ligaments, surgical intervention is needed to reconstruct the soft tissues and bring stability back to the ankle joint.

Diagnostic imaging may also be done, such as an X-ray, ultrasound, CT scan, or MRI to assess the ankle joint structures.

If your GP determines that your sprained ankle could be treated without surgery, they may coordinate with your physio to provide you with proper treatment and further assessment.

What is the recovery time / prognosis for a rolled ankle?

Ultimately, recovery time is dependent on being proactive and seeking professional treatment,along with the severity of your ankle pain and injury.

Physiotherapy generally leads to good outcomes and faster recovery for patients. If treated with physiotherapy, most cases of an ankle sprain can resolve within 2 to 4 weeks or less.[4]

Important factors in recovery include:

• Sticking to your rehabilitation program and regularly exercising

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

You may immediately feel signs of relief during your physiotherapy. However, you will be asked to continue with your program to strengthen your muscles and improve your balance to help prevent future injuries.

One of the key factors to recovery is also trying to prevent further recurrences of an ankle sprain.

Strengthening and balance retraining are critical components of rehabilitation to minimise the risk of another ankle sprain.

Can a sprained ankle be prevented?

Guaranteeing prevention can be impossible; however, you can decrease the risk of a sprained ankle through some of these techniques:

• Strengthen your muscles - Keeping your lower body muscles strong by regular exercise will prevent soft tissue injuries and allow your joints’ greater stability. Your physio will provide you with optimised training exercises to keep your lower body strong and prevent injuries.

• Maintain flexibility - Maintaining the flexibility of your muscles through stretching, yoga, or tai chi will help you maintain your ankle joint’s natural range of motion.

• Warm-up before doing athletic activities - Preparing your body before an intense workout is crucial for preventing injuries. Do stretching and warm-up exercises for the whole body before engaging in sports.

• Wear properly fitting shoes - Use shoes that fit properly and protect you from injuries. Each person has different footwear needs depending on their anatomy. Consult your physiotherapist for assessment and recommendation.

• Maintain a healthy weight - Your foot and ankle joint carry most of your body weight and are constantly under stress during weight-bearing activities. Managing your weight decreases pressure on the structure of your ankle joints, lessening the chance of injury.

Outlook and the main takeaways

One of the most important messages to take away is that pain and swelling is a signal from your body that your ankle is injured, and that you should do something about it. There are many causes, symptoms and severities of ankle pain, and also a high chance of re-injury if your recovery is not well managed. Take the first steps to recovery and book an appointment with a physiotherapist today!

Anatomy of the ankle

The ankle joint comprises three bones, the bones of your leg (tibia and fibula) and the ankle bone (talus). These bones are connected via solid ligaments that provide stability in the ankle joint.

Here are the ligaments inside the ankle joint:

• Anterior talofibular ligament (ATFL)

• Calcaneofibular ligament (CFL)

• Posterior talofibular ligament (PTFL)

• Deltoid ligament complex.

Overstretching of any of these ligaments beyond their capacity will result in tearing and damage. Twisting or rolling of your foot during walking or running is usually the cause of a sprained ankle.