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Posted: January 13, 2009

Sportsmedicine: Ankle Injuries, Ankle Pain and Sprained Ankle Treatment

A guide for the prevention and treatment of ankle injuries

Part 1
Ankle Injuries are one of the most common injuries faced by anyone who participates in sport or exercise. As a matter of fact, you don't even have to be engaged in any exercise to suffer from a sprained ankle. It seems that even while minding your own business, an ankle injury can occur.

Ankle injuries are commonly associated with sports that require a lot of running, jumping and change of direction. Excessive twisting or turning of the ankle joint results in a rupture of the ligaments that hold the ankle in place.

I've had many requests for an article on sprained ankles, so to follow is the most comprehensive information I could put together. In fact, I found it hard to fit it all into one issue, so I've decided to split it into two parts.

In the first part, we're going to have a look at exactly what a sprained ankle is. I'll go over the structures that make up the ankle joint; we'll have a look at what happens when an ankle injury occurs; we'll check out the symptoms associated with an ankle injury; and then we'll finish off with a look at the major causes and risk factors that contribute to ankle injury.

In the second part you'll find the most complete treatment, rehabilitation and prevention information available anywhere. I'm going to outline a detailed, step-by-step process of firstly treating the initial injury and then making sure you never have to worry about ankle injuries again.

What is an Ankle Sprain?
An ankle sprain is an injury that results from a twisting action, which stretches or tears the ligaments of the ankle joint. (The term sPrain refers to an injury of the ligaments, as opposed to a sTrain, which refers to an injury of the muscle or tendon.) Remember; ligaments attach bone to bone, were as tendons attach muscle to bone.

The foot and ankle joint is a very complex structure, made up of many bones, ligaments, muscles and tendons. As you can see from the diagram below there are many opportunities for an injury to occur at the ankle.

When an ankle injury does occur it usually affects one or more of the ligaments that help to hold the ankle joint in place. However, if the injury is severe enough damage may also occur to the tendons that attach the muscles to the bones.

There are a number of ligaments that keep the ankle joint in place and prevent a loss of stability. The ligaments that are commonly affected by an ankle sprain are the ones located on the lateral side (or outside) of the ankle.

The three major ligaments that help to stop the ankle from rolling forward and outward are the anterior talofibular ligament, the posterior talofibular ligament and the calcaneofibular ligament.

These ligaments can be seen in the diagram to the right, and are located at the bottom edge of the circle.

Injuries to the ligaments of the ankle are usually graded into three categories, and these injuries are referred to as: first; second; or third degree sprains.

A first degree sprain is the least severe. It is the result of some minor stretching of the ligaments, and is accompanied by mild pain, some swelling and joint stiffness. There is usually very little loss of joint stability as a result of a first degree sprain.

A second degree sprain is the result of both stretching and some tearing of the ligaments. There is increased swelling and pain associated with a second degree sprain, and a moderate loss of stability at the ankle joint.

A third degree sprain is the most severe of the three. A third degree sprain is the result of a complete tear or rupture of one or more of the ligaments that make up the ankle joint. A third degree sprain will result in massive swelling, severe pain and gross instability.

One interesting point to note with a third degree sprain is that shortly after the injury, most of the localized pain will disappear. This is a result of the nerve endings being severed, which causes a lack of feeling at the injury site.

From the explanations above you can see that pain and swelling are the two most common symptoms associated with an ankle sprain. You can also expect some bruising to occur at the injury site. The associated swelling and bruising is the result of ruptured blood vessels.

Causes and Risk Factors
There are a number of causes and risk factors associated with an ankle sprain. One of the most common causes is simply a lack of conditioning. If the muscles, tendons and ligaments around the ankle joint have not been trained or conditioned, this can lead to a weakness that may result in an ankle sprain.

A simple conditioning program that helps to even out any imbalances at the ankle will help considerably. For example, the calf muscles may be much stronger than the muscles in the front of the leg. This would lead to a strength imbalance. Or, maybe the Achilles is very tight while the anterior muscles are very flexible. This would lead to a flexibility imbalance. (In part 2, I'll go into a lot more detail about conditioning and imbalances.)

A lack of warming up and stretching is another major cause of ankle injuries. In an article titled, "Ankle Injuries in Basketball: injury rate and risk factors," by McKay, Goldie, Payne & Oaks, in the British Journal of Sports Medicine; the article states that "Basketball players who did not stretch during the warm up were 2.7 times more likely to injure their ankle than players who performed stretches."

There is also a number of other less common causes of an ankle sprain. They include things like wearing inadequate footwear, running or training on uneven ground, and simply standing on, or in something you're not meant to.

However, the most common risk factor associated with ankle sprains is a previous history of ankle sprains. In other words, if you've had an ankle injury in the past, chances are you're going to suffer another one if you don't take some precautions and do some conditioning exercises to strengthen your ankle.

Gail McKay, in a recent Sport Health article titled "Risk Factors for Ankle Injuries" stated; "The most common risk factor identified was a history of ankle injury. Therefore, ankle-injured athletes tend to face the downward spiral of recurrent ankle injuries. Hence, ankle injured athletes should be encouraged to undertake comprehensive ankle rehabilitation programs."

In part 2 that's just what we're going to do. I'll be outlining a comprehensive initial and ongoing treatment program. Part 2 will be posted next week.

Article Posted on the Stretching Institute by Brad Walker.
Brad is a leading stretching and sports injury consultant with nearly 20 years experience in the health and fitness industry. For more free articles on stretching, flexibility and sports injury, subscribe to The Stretching & Sports Injury Newsletter by visiting

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