Ankle Sprains: Explained!

What Is an Ankle Sprain?

Ankle sprains are extremely common across all populations, not just athletes. Most people will experience at least one sprain in their lifetime, and while many recover well, a poorly managed sprain can be painful, frustrating and impact daily function.

During an ankle sprain, the ligaments that support the joint become overstretched or torn. This leads to pain, swelling and difficulty walking or bearing weight.

Ankle Anatomy

To understand ankle sprains, it helps to know the structures involved.

Lateral (Outside) Ankle Ligaments

There are three main ligaments on the outside of the ankle:

• Anterior talofibular ligament (ATFL): Located at the front of the ankle and the most commonly injured ligament
• Calcaneofibular ligament (CFL): Situated in the middle, connecting the fibula to the heel bone.
• Posterior talofibular ligament (PTFL): Located at the back of the ankle.

Medial (Inside) Ankle Ligament

• Deltoid ligament: A strong, fan-shaped ligament that stabilises the inside of the ankle.

Syndesmosis or High Ankle Sprain

• In some cases, the ankle’s syndesmosis complex can be injured. This is a group of ligaments that sit above the ankle joint, connecting the tibia and fibula.
• Syndesmosis injuries are typically more painful than standard lateral sprains and generally require longer rehabilitation due to their role in stabilising the lower leg and ankle during weight-bearing activities and sports.
• Depending on the severity of the injury, your age, and the type of activity or sport you aim to return to, syndesmosis sprains may require a surgical opinion from an orthopaedic surgeon if the ankle becomes unstable.

Why Rehabilitation Matters

Although ankle sprains are common, proper rehabilitation is essential to:

1. Restore functional movement (strength and range of motion)
2. Reduce the risk of future sprains
3. Enable a safe return to sport and activity

Without specific rehab, the ankle can remain weak or unstable, increasing the likelihood of re-injury.

How Can a Physiotherapist Help?

1. Subjective Assessment

This involves discussing a thorough history of your injury and formulating an appropriate assessment and treatment plan

Your physiotherapist will gather detailed information about:

• Mechanism of injury
• The movements or activities involved
• Current symptoms and limitations

This helps guide the clinical assessment and treatment plan.

2. Objective Assessment

Your physiotherapist will perform functional and structural tests to identify which tissues have been damaged. This may include:

• Assessment of bony tenderness: This is essential for determining whether an X-ray or further imaging is required. This is important because fractures or severe sprains may need a period of immobilisation in a boot or brace, which can change early management.
• Functional tests such as calf raises, squats, hopping and jumping
• Strength testing of the surrounding muscles. These can be great outcome measures to compare pre- and post-injury status throughout rehabilitation
• Ligament integrity tests to assess the severity of the sprain

3. Treatment and Rehabilitation Exercise

Your physio will design a progressive exercise program tailored to your injury, activity level and goals.

Key components include:

Range of Motion (ROM)

Often the first stage of rehab, ROM exercises help restore normal walking patterns and reduce stiffness. Movement may initially be limited due to swelling or pain.

Strengthening

Rebuilding strength is essential for recovery. Muscles commonly targeted include:

• Calf muscles
• Fibularis longus and brevis
• Tibialis posterior
• Flexor hallucis longus (FHL)
• Intrinsic foot muscles

Balance and Proprioception

After a sprain, proprioception - the body's ability to sense joint/limb position, can be reduced. This contributes to poor balance and increases the risk of future sprains.

Poor proprioception → Decreased foot position awareness → Poor balance → Increased risk of re-injury

Targeted balance training helps:

• Improve foot position awareness
• Strengthen the intrinsic foot muscles (small muscles located under the foot)
• Enhance stability, especially on uneven surfaces e.g., footpaths, grass

Return to Sport or High-Level Activity

Once strength and stability of the ankle improve, your physio will introduce sport-specific or lifestyle-specific exercises including:

• Hopping and jumping
• Agility and reaction drills
• Directional changes
• Advanced balance drills mimicking sport-specific requirements
• Explosive power movements
• Running

These prepare the ankle to handle the demands for higher level activity and sport, to perform at pre-injury levels and reduce risk of recurrence.

If you have experienced a recent or recurrent ankle sprain, book in today to have it assessed by one of our friendly physiotherapists to get you back on the field and to activities you love.