Ankle sprains are one of the most common injuries presenting to Accident and Emergency department and can occur in the young or old, active or sedentary populations.
Approximately 80% of all ankle sprains occur to the outside of the ankle. Symptoms include pain, swelling, bruising and joint stiffness. The picture below shows a typical lateral ankle sprain after 1 week.
A recent review of 23 studies by Hoch and McKeon (2013) found that the reoccurrence rate of re-spraining was as high as 70%. Another study by Wikstrom et al (2013) found that 30% of people who suffer a lateral ankle sprain go on to develop chronic ankle instability (recurrent episodes of spraining). Even more worrying is that 2/3rds of those with chronic ankle instability develop post-traumatic osteoarthritis of the ankle.
Given the above figures you would expect that physiotherapy clinics would see a large amount of acute ankle sprains each week. Surprisingly we don’t, and this is most likely due to the fact that the vast majority of sprains improve by 4-6 weeks. However, people generally measure improvement by their pain levels and/or how much swelling or bruising is present. Recent studies have demonstrated that patients who suffer from chronic ankle instability have alterations in their sensorimotor system and muscle activation patterns are delayed.
All of the above research says that ankle sprains should not be thought of as a simple injury that gets better naturally. The role of physiotherapy in the management of an ankle sprain should look further than just reducing pain and swelling. Strength of lower limb muscles such as the peroneals, restoring hip control and explosive power of the calf muscles are some of the important components of ankle rehabilitation that need consideration for weeks, sometime months past the point of resolution from pain and swelling. Several studies have demonstrated that a strength and balance rehabilitation program for patients with chronic ankle instability can be an effective treatment for improving function.
So next time you have a “simple” ankle sprain, be sure to engage in a rehabilitation program that looks for returning strength and function, and does not concentrate purely on reducing pain and swelling.