Ankle sprains are one of the most common musculoskeletal injuries, especially among active individuals and athletes. While they may seem minor at first, improper treatment or neglect can lead to chronic instability and long-term complications. Physiotherapy plays a crucial role not only in recovery but also in preventing future recurrences.

What is an Ankle Sprain?

An ankle sprain occurs when the ligaments supporting the ankle joint are overstretched or torn, usually due to a sudden twist, roll, or turn. Ligaments are strong bands of connective tissue that hold bones together and provide stability to the joint. When these are damaged, the result is pain, swelling, and reduced mobility.

Causes of Ankle Sprain

The most common cause of an ankle sprain is a sudden misstep or trauma that forces the ankle out of its normal position. This can happen during:

  • Walking or running on uneven surfaces
  • Landing awkwardly from a jump
  • Sudden directional changes in sports
  • Wearing improper footwear

Sports Where Ankle Sprains Are Most Common

Ankle sprains are especially common in sports that involve jumping, running, or rapid changes in direction. These include:

  • Basketball
  • Football (soccer and American)
  • Volleyball
  • Tennis
  • Trail running
  • Gymnastics

Common Age Groups Affected

Although ankle sprains can affect people of all ages, they are particularly frequent among:

  • Teenagers and young adults engaged in sports
  • Middle-aged individuals participating in recreational activities
  • Older adults with balance issues or reduced proprioception

Early Symptoms of an Ankle Sprain

Physiotherapists often see patients presenting with:

  • Sudden pain at the side of the ankle
  • Swelling and bruising
  • Difficulty bearing weight
  • Tenderness to touch
  • Limited range of motion
  • A feeling of instability

Early physiotherapy assessment is crucial to rule out fractures and assess the grade of the sprain.

Incidence of Ankle Sprains

General Population

  • In the United States, the incidence rate of ankle sprains is approximately 3.29 per 1,000 person-years, based on emergency department data from 2010.

Athletic Populations

  • Among collegiate athletes, ankle sprains are the most common reported injury, making up 15% of all injuries.
  • Incidence Rate: Ranges from 0.75 to 0.89 sprains per 1,000 athlete exposures.
  • Sport-Specific Rates:
    • Basketball: 21.9%
    • Football: 9.3%
    • Soccer: 7.6%

High-Risk Sports

  • Activities involving running, cutting, and jumping (e.g., basketball, football, soccer, volleyball) show higher incidence rates.
  • Example: Men’s spring football and basketball report 1.30 to 1.34 per 1,000 athlete exposures.

Demographic Variations

  • Age: Individuals aged 10–19 years show the highest incidence, likely due to increased physical activity.
  • Gender:
    • Females: 13.6 per 1,000 exposures
    • Males: 6.94 per 1,000 exposures

Types and Severity

Lateral Ankle Sprains:

  • Most common (approx. 85% of ankle sprains).
  • Typically involve ATFL (Anterior Talofibular Ligament) and CFL (Calcaneofibular Ligament).

High (Syndesmotic) Ankle Sprains:

  • Less common but more severe.
  • Make up around 15% of sprains.

Recurrence and Chronic Issues

Recurrence Rates:

  • 20–40% may experience repeat sprains within 1–2 years.

Chronic Ankle Instability:

  • Affects approximately 40% of individuals with a history of ankle sprains.
  • Leads to persistent discomfort and limitations.

Age-wise Breakdown

Age Group Initial Ankle Sprain Chronic Ankle Sprain Recurrent Ankle Sprain
6–12 years 40% 22.05% 85.29%
12–15 years 30%
15–18 years 27% 5.82% 66.99%
18+ years 5%

The Role of Physiotherapy in Ankle Sprain Recovery

Physiotherapists are essential in every stage of ankle sprain management — from acute care to full return to activity. Here’s how:

Acute Phase Management

In the first 24–72 hours, the focus is on:

  • Reducing pain and inflammation using manual therapy, cryotherapy, and modalities like ultrasound or TENS
  • Educating patients on R.I.C.E. principles (Rest, Ice, Compression, Elevation)
  • Protecting the joint with bracing or taping if necessary

Restoring Mobility and Strength

Once pain and swelling reduce, the physiotherapist guides:

  • Gentle joint mobilization to restore range of motion
  • Targeted exercises to strengthen muscles around the ankle, especially the peroneals and calf group
  • Proprioceptive training to enhance balance and joint awareness

Functional Rehabilitation

This phase focuses on:

  • Sport-specific or activity-specific drills
  • Plyometric exercises (if needed for athletes)
  • Agility and coordination training
  • Taping or bracing strategies for return to sport

Preventing Reinjury

A key role of physiotherapy is minimizing recurrence through:

  • Long-term balance and strength training
  • Education on proper footwear and surface awareness
  • Guidance on warm-up routines and technique correction

Conclusion

An ankle sprain may seem like a small setback, but without proper physiotherapy intervention, it can turn into a chronic issue. Physiotherapists not only treat the injury but empower individuals to regain full function and prevent future sprains. Early assessment and a structured rehab plan are the keys to a strong, stable, and sprain-free ankle.

Authors: Dr Sarath E (PT) BPT

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