Ankle Sprain
I have sprained both ankles too many times to count. It makes sense given that, growing up I chose sports that were much more inclined to result in ankle sprains, including cross country (trail running) and tennis. For many years, re-spraining my ankles was a chronic issue for me, I’ve even stepped on an ACORN (for Pete’s sake!) and fall to the ground in agony after re-spraining one ankle or the other. (Not to mention I can be kind of dramatic). However, in the last 10 years of my education through yoga therapy training, and developing my personal practice of functional movement and yoga, I haven’t (knock on wood!) resprained my ankle.
The ankle sprain, and subsequent resprain, is not uncommon however. In fact, it's the most common injury in athletics. There are three main types of ankle sprains:
Inversion/Lateral Sprain
Eversion/Medial Sprain
High Ankle Sprain
The inversion/lateral ankle sprain is the most common and typically what you think of when people say they “rolled their ankle”. When this happens, the heel turns inward, inverting the ankle, and spraining the lateral ligaments of the joint. There are three different ligaments that make up the lateral ligament complex: anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The ligaments are named based on the bones to which they attach. And there are three bones that make up the ankle joint: the tibia, fibula, and talus. The calcaneus sits right underneath the talus. The ATFL is sprained in 70% of inversion sprains, and usually in an inversion/plantarflexion moment.
The medial ligaments of the ankle, called the deltoid ligament as a whole, are much stronger than the lateral ligament complex, so eversion sprains are much less common. There are also three different ligaments that make up the deltoid ligament: anterior tibiotalar ligament, tibiocalcaneal ligament, and posterior tibiotalar ligament.
High ankle sprains are also relatively rare and involve the syndesmotic ligaments, which are the ligaments between the tibia and fibula that hold the two bones together down near the ankle joint. It takes a large amount of force to tear or sprain these ligaments, so this type of ankle sprain is mainly only seen in sports-related injuries. The most common way these ligaments are sprained is with hyper-dorsiflexion and/or eversion (foot up, heel out).
Treatment of acute injuries, including ankle sprains, is seeing a major overhaul in Western medicine. We used to recommend RICE (rest, ice, compression, elevation). However, current evidence is very “anti-ice” and pro-“get moving ASAP”. Many now follow two new acronyms: PEACE and LOVE. Super cheesy, but easy to remember! PEACE follows the mantra “immediately after a soft tissue injury, do no harm and let PEACE guide your approach”. PEACE stands for:
P = Protect - unload or restrict movement for 1-3 days to reduce bleeding, prevent swelling, and reduce risk of re-injury. However, minimize rest and let pain be your guide towards removal of protection.
E = Elevate - still the same as before - elevate above the heart with the idea that gravity will promote movement of swelling out of the tissues.
A = Avoid Anti-Inflammatories - oral anti-inflammatories may negatively affect long term healing. This also includes ice, which is mostly for pain-relief, and also may negatively affect the body’s natural healing process.
C = Compress - also still the same - swelling and bleeding may be decreased by external compression.
E = Educate - patients need better education about their injury. The dependence on passive treatments may contribute to persistent symptoms. Active rehab approaches have been shown to have better outcomes with pain relief and return to function.
LOVE follows the mantra “after the first days have passed, soft tissues need LOVE”. LOVE stands for:
L = Load - normal activities should continue as soon as symptoms allow and early loading without pain promotes tissue repair and remodeling, builds tissue tolerance and capacity of the tendons, muscles and ligaments.
O = Optimism - the brain plays a large role in recovery and pessimistic patient expectations can influence outcomes. Research has shown that depression, fear, and catastrophization may more explain the variation in symptoms and limitations following ankle sprains than the degree of soft tissue injury!
V = Vascularization - pain free cardiovascular activity increases blood flow to injured tissues and is a motivation booster. Early mobilization and aerobic exercise have been shown to improve function and decrease the need for pain meds.
E = Exercise - evidence supports the use of exercise in the treatment of ankle sprain, which also reduces the risk of recurrence. Again, avoid pain in the early stages of recovery to promote optimal repair and then use pain as a guide to progress exercises gradually.
The good news is, that my ankles have DRAMATICALLY improved since I started doing my daily yoga practice and functional movements over six years ago. Restoration of proprioception, strength, balance and mobility are all a part of the blueprint to how I teach. It’s also a great way to strengthen the foot and ankle to prevent ankle sprains from happening in the first place! So join me on the mat!