Ankle sprains are among the most common musculoskeletal injury, especially those sustained while playing sports. There are a few types of an ankle sprain; lateral ligament sprain following an inversion injury, medial ligament sprain following an eversion injury or a “high ankle sprain” usually involving the syndesmosis. The most common of these is the lateral ligament sprain which is sustained when your foot and ankle turn inwards, stretching the ligaments and other soft tissues on the outside of your ankle. Almost all soft tissue injuries are graded 1,2, or 3, often described as mild, moderate and severe. Depending on which ligaments you’ve injured, the recovery timeframes are closely linked to the grade of your injury.
Explaining the ankle injury
While the most common injury is the lateral ligament sprain, your ankle needs to be assessed and diagnosed accurately. There are numerous other structures to be assessed to ensure you don’t have a fracture (including hairline fractures), bone or cartilage bruising, which takes longer to heal, or tendon injuries, including traumatic tendinitis/tendinopathy or tendon tears. If all these possible diagnoses are excluded, and it’s determined that you have only injured your ligaments, then your injury will need to be graded.
Ankle Sprain Grades
Grading of ankle ligament injuries can typically be done clinically by a physiotherapist without imaging, and there are only three grades to consider. Grade 1 injuries result in overstretching and straining of the ligament, with up to 10-15% of the ligament injured. Grade 2 injuries involve partial tearing of the ligament, but can range significantly from 15% up to 80-90% of the ligament. For this reason, physiotherapists often sub-classify into grades 2-, 2 and 2+ to help better understand the size of the partial tear. Grade 3 injuries typically involve a complete tear of the ligament. Given both Grade 2 and 3 injuries involve macro tearing of the ligament, it is very normal to see bruising appear a day or two after your injury. If there is any uncertainty or inconsistency with the clinical/physical assessment or other possible injuries could be involved, then imaging can be done to confirm the diagnosis.
Healing from an Ankle Sprain
Healing timeframes can vary depending on the presenting factors. Average healing timeframes for Grade 1 injuries is 2-3 weeks, Grade 2 injuries take 4-6 weeks, and Grade 3 injuries often take 10-12 weeks. These timeframes refer to the tissue healing time and not the reduction of swelling or pain, which can last longer if there are secondary issues.
Wait it out?
Reading the above, many will wait for the body to heal, expecting all to be fine. The healing timeframes are not typically able to be sped up, but recovery will be more successful if you address the secondary issues that occur. These can include swelling, stiffness in the joint and weakness. Improving the range of movement in the ankle should make walking easier, and reducing the swelling can help if the ankle aches by the end of the day. Improving strength will increase stability, along with helping prevent re-injury when you are ready to return to sport.
When can you return to sport after an ankle sprain?
While the healing timeframes are important to consider with your return to sport, there are several tests that can be done to assess your readiness to return to sport. Strength and stability are certainly considered, along with agility and muscle memory. Typically, you can start addressing these factors (in a controlled environment) while the body is healing, and so once the body is healed, there are no unnecessary delays to your return to sport. For example, proprioception exercises and running in a straight line can be commenced as part of a planned rehabilitation program prior to pivoting and turning etc.
Ankle sprains are common and easily addressed/treated, but if not managed well can, unfortunately, become recurrent. If you have injured your ankle recently or are looking to return to sport and are not sure if the stability and agility have fully recovered, contact us at Fairfield Physiotherapy for a thorough assessment and treatment to get you back to full fitness.