Ankle sprains occur when the ligaments supporting the ankle overstretch and tear. It can be caused by rapidly changing directions, treading a ball or just clumsily rolling your ankle while walking along the street. After getting over the initial shock, pain and possible embarrassment of spraining your ankle, one of the first questions that come to mind is: ‘Can I still continue playing sport or doing this exercise?’ Knowing the type and severity of the sprain helps indicate whether you can continue playing and what kind of management required.
Types of ankle sprains:
Inversion sprain: The most common type of ankle sprain. Occurs when the ankle rolls inwards, causing the ligaments on the outside of the ankle to overstretch (anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament).
Eversion sprain: Occurs when the ankle rolls outwards and overstretches the ligaments on the inside of your ankle (deltoid ligament).
Though not as common, it is important not to immediately rule out more serious ankle injuries such as syndesmosis sprains (high ankle sprains), broken bones or avulsion fractures. These types of injuries require more aggressive management and can take over 3 months to return to playing sport.
A grading system helps determine the severity of the sprain and gives a rough guideline on when to return to sport.
Grade 1: Involves stretching and microscopic tears of the ligament fibres. There will be mild tenderness and swelling around the ankle joint. Return to sport is approximately 1-2 weeks.
Grade 2: Involves partial tearing of the ligament(s), moderate tenderness and swelling and an abnormal looseness in the joint. Return to sport is approximately 3-6 weeks after initial injury.
Grade 3: Involves a complete tear of the ligament(s), significant tenderness and swelling and substantial instability in the joint. You may be immobilised in a boot and surgery may be required. It can take over 4 months to return to sport, depending on the management required.
Swelling may occur within the first 3 hours of injury, and can continue to increase over the next 72 hours to a varying degree. It is not recommended to play sport during this time, but to ice, compress and elevate it.
The type of sport you play and the priorities of your team also affect the decision in when to return to sport. It is safest to return once you have full range of motion, stability and balance in order to prevent recurrence. A comprehensive rehabilitation program is required to achieve these goals, along with manual therapy to help increase mobility. Ankle sprains have one of the highest recurrence rates; therefore it is important to be cleared by your practitioner to return to sport in order to prevent re-injury.