Sports Injuries - Ankle Sprain

About 13 million adults and 3 million children take part in sport each year in Australia (Department of Health and Aged Care.)

While this has many benefits, it also puts us at risk of sports injuries. In 2019–20 alone, about 52,300 sports injuries led to a hospital stay in Australia (AIHW).

Among the different sports injuries the most common ones are the injuries of the soft tissue — sprains, strains, tears and bruises

Ankle sprains

Ankle sprains are a prevalent type of sports injury, characterised by the tearing of ligaments that join bones together and support the joint's stability.

Sports that involve jumping, twisting, and turning movements like basketball, volleyball, netball, and football, as well as those that require sudden changes of direction like soccer, tennis, and hockey, have a higher risk of causing ankle sprains.

After experiencing an ankle sprain, the joint may become unstable, leading to a prolonged recovery period.

Risks

An excessive range of motion at the ankle joint caused by external force can result in an acute ankle sprain. Players typically become immediately aware of the injury and may hear an audible "snap" or "pop" sound.

Proven risk factors

• A previous or existing ankle injury, especially if poorly rehabilitated (biggest risk factor).
• Lack of strength and stability related to the ankle.
• Lack of, or extreme flexibility, in the ankle joint.
• Poor balance.
• Sudden change in direction (acceleration or deceleration).
• Increasing age of player.

Suspected risk factors

• Poor condition of the playing surface.
• No warm-up or warm-up that’s inadequate.
• Wearing inappropriate footwear for the activity.
• Lack of external ankle support (taping, bracing) for previously injured ankles.

Prevention

• Undertaking training prior to competition to ensure readiness to play.
• Gradually increasing the intensity and duration of training.
• Undertaking flexibility, balance, stretching and strengthening exercises in weekly training programs.
• Including agility work in training programs so the ankle joint is capable of sustaining high acceleration forces and quick changes in direction.
• Allowing adequate recovery time between workouts or training sessions.
• Warming up to ensure surrounding muscles are ready to support the joint during activity.
• Wearing ankle taping or bracing especially for previously injured ankles.
• Wearing shoes appropriate to the sport that provide stability and support.
• Checking the training and playing area to ensure a flat and even surface.
• Drinking water before, during and after play.
• Avoiding activities that cause pain.

Signs and Symptoms

Sprains are graded on a scale of 1 to 3 (mild, moderate, and severe), depending on the degree of tearing to the ligaments. In most cases, x-rays are performed to rule out a fracture or dislocation.

Grade	Description
1 (mild)	Minor tear Minimal pain Little or no joint instability Mild pain with weight bearing activities Slight loss of balance
2 (moderate)	Some tearing of the ligament fibres Moderate to severe pain Moderate instability of the joint Swelling and stiffness Pain with weight bearing activities Poor balance
3 (severe)	Complete tear of the ligament Severe pain followed by minimal pain Gross instability of the joint Severe swelling Possible pain with weight bearing Poor balance

Treatment

To manage an acute ankle sprain:

Implement the RICER protocol for 48–72 hours:

• Rest
• Ice - Apply an ice pack for 20 minutes every two hours (never apply ice directly to the skin).
• Compression - Apply a correctly sized compression bandage to limit bleeding and swelling in the joint.
• Elevation - Rest leg in an elevated position.
• Referral - A doctor should be seen as soon as possible after the injury to determine the extent of the injury and to advise on treatment and rehabilitation.

To reduce bleeding and swelling in the injured area, it is also important to adhere to the No HARM protocol, which involves avoiding heat, alcohol, running or activity, and massage.

Rehabilitation and return to play:

Most ankle sprains heal within 2 to 6 weeks, however severe sprains many take as long as 12 weeks.

A comprehensive rehabilitation program minimises the chance of the injury recurring and includes flexibility, balance, stretching, strengthening and sport specific exercises.

During this time, taping or bracing the ankle may be prescribed to provide support until full function is regained. If, while performing a rehabilitation exercise, ankle joint pain or discomfort is experienced, stop immediately and re-consult a sports medicine professional.

Players with significant ligament injuries (Grade 2 or 3) are advised to use bracing or protective taping when playing sport for a minimum of 6 to 12 months post injury.

References:

2023 About Sport in Australia. Australian Government. Department of Health and Aged Care

2019-20 Sports Injuries Hospitalisations in Australia. Australian Institute of Health and Welfare

Sports Medicine Australia