Ankle Sprains: Avoiding the Route to Chronic Pain
- Dr. Brian Abelson
- Aug 23, 2024
- 13 min read
Ankle sprains are among the most common sports injuries, accounting for about 40% of all cases. The majority are inversion sprains, affecting the lateral side of the ankle, which make up 85% of these injuries. Medial ankle sprains, often linked to fractures, are less common but still significant. The difference lies in anatomy: the lateral malleolus (the outer ankle bone) sits lower than the medial malleolus (the inner ankle bone), offering more stability to the inner ankle. Without proper treatment, ankle sprains can lead to chronic pain, recurring injuries, and complications like osteoarthritis.
Our Success Rate is Over 90%
Our over 90% success rate in treating Ankle Sprains is due to our multimodal, interdisciplinary approach, which focuses on pain relief and improved function.
Article Index:
Ligamentous Architecture
The stability of the ankle’s outer side depends on three main ligaments: the Anterior Talofibular Ligament (ATFL), the Calcaneofibular Ligament (CFL), and the Posterior Talofibular Ligament (PTFL).
In an inversion sprain, where the ankle twists inward, the ATFL is typically the first to be injured. Ligaments are named for the bones they connect—in this case; the ATFL connects the talus bone in the ankle to the fibula, a critical bone in the lower leg. The ATFL’s primary role is to prevent the talus from shifting forward, helping to keep the ankle stable.
Ligament Injuries in Severe Ankle Sprains
The Calcaneofibular Ligament (CFL), which connects the heel bone (calcaneus) to the fibula, may also be injured in a severe ankle sprain. It is generally stronger than the ATFL.
Movements in which the foot is pointed downward (plantar flexion) and rolls inward (inversion) can damage both the ATFL and CFL, leading to significant ankle instability.
The Posterior Talofibular Ligament (PTFL), the strongest ligament in the lateral ankle complex, is rarely injured unless there’s a complete ankle dislocation.
A more severe type of sprain, known as a 'High Ankle Sprain,' involves the syndesmotic ligament complex. This injury tears the ligament and connective tissue between the tibia and fibula, often requiring surgical intervention.
The Kinetic Chain of Ankle Sprains
Ankle sprains affect more than just ligaments—they impact connective tissues, tendons, muscles, and nerves. Understanding the complexity of these injuries, especially lateral and high ankle sprains, is key to effective treatment and prevention.
Tendons: During an inversion sprain, the Peroneal Tendon is often affected. As healing progresses, this tendon may shift from its normal position, leading to subluxation, a partial dislocation. Proper realignment during recovery is crucial for optimal healing.
Muscles: The Peroneus Brevis and Peroneus Longus muscles are commonly involved in ankle sprains. Lateral sprains can cause longitudinal tears in the Peroneus Brevis, while the Peroneus Longus may show altered activation due to muscle constraints from ankle instability. If these issues aren’t addressed, re-injury is likely. These muscles play a critical role in rolling the foot outward at the tarsal joint and flexing the foot downward at the ankle.
Retinaculum: Think of the retinaculum as a strong belt of connective tissue that keeps the peroneal tendons securely in place. A tear in this 'belt' can cause a snapping sensation in the outer ankle. In severe cases, retinaculum tears may not heal with manual therapy alone and could require surgical intervention.
Understanding the anatomy of these injuries is crucial for creating a comprehensive treatment plan for ankle sprains. This holistic approach aids in healing and lowers the risk of future sprains.
Ankle and Foot Examinations
Diagnosing and treating ankle sprains requires a thorough examination of the ankle and foot, using three key tests: orthopedic, neurological, and vascular.
Orthopedic tests focus on bones, muscles, and ligaments to pinpoint specific areas that need attention.
Neurological tests assess nerve function to rule out any nerve-related issues.
Vascular assessments ensure proper blood circulation, which is vital for healing.
We've created a series of demonstration videos to illustrate the importance of these exams in managing ankle sprains and related conditions. These visual guides deepen your understanding of these essential evaluation processes.
Effective Ankle and Foot Examination
This video uses orthopedic tests to evaluate some of the most common ankle and foot conditions we see in clinical practice. These conditions include Ankle Sprains (inversion sprain), Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fracture, Syndesmosis damage, Achilles Tendon Tendinopathy, Morton's Neuroma, 2nd Metatarsal Stress Fracture, Plantar Fasciitis, and Bunions.
Lower Limb Neuro Examination
The lower limb neurological examination is part of the overall neurological examination process and assesses the motor and sensory neurons that supply the lower limbs. This assessment helps detect any impairment of the nervous system and is used both as a screening and an investigative tool.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is valuable for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. This video reviews some common procedures we perform in daily clinical practice.
Imaging
Imaging is vital in diagnosing and assessing the severity of ankle sprains, offering detailed insights into the underlying anatomy and potential damage.
X-rays are often the first step used to rule out fractures and check the alignment of the ankle joint.
Ultrasound offers real-time views of soft tissues, helping to identify ligament tears or tendon issues.
MRI is reserved for more severe or complex cases. It provides detailed images of both soft and hard tissues, including any damage to ligaments, tendons, or cartilage.
These imaging techniques together provide a comprehensive understanding of the injury, which is essential for developing an effective treatment plan.
The Acute Stage
When an ankle sprain occurs, your first priority should be to reduce swelling immediately. Quick action can significantly shorten healing time, while delays may prolong discomfort.
In the immediate aftermath, follow the RICE protocol: Rest, Ice, Compression, and Elevation.
Rest: Initially, keep weight off the injured ankle, possibly using crutches. However, reintroducing weight-bearing as soon as it’s comfortable is crucial for faster healing. Don’t rush—rest remains essential.
Ice: Apply an ice pack for 20–30 minutes, 3-4 times daily, to reduce swelling. Generally, icing isn’t recommended beyond 72 hours post-injury.
Compression: Use an ACE wrap to minimize swelling and bleeding. For a Grade 3 sprain, it is advisable to wear a brace consistently until you can comfortably bear weight.
Elevation: Elevate the injured ankle to further reduce swelling and bleeding.
After completing the RICE protocol, start moving the ankle as soon as possible. Depending on the injury’s severity, gentle ankle rotations, ‘drawing’ the alphabet with your foot, light calf stretching, and using a stationary bike can be beneficial.
Ankle Exercises - Acute Injury
This video demonstrates ankle mobilization exercises suitable for the acute stage of an ankle injury. These exercises are often combined with the RICE protocol—Rest, Ice, Compression, and Elevation—to promote fluid exchange and help remove waste by-products during the early recovery phase.
Manual Therapy: A Key to Ankle Sprain Recovery
Manual therapy is vital for healing and preventing ankle sprains. It boosts blood flow, oxygenation, and nutrient delivery to the injury site, accelerating recovery. Additionally, it helps remove waste products that can accumulate after an injury, which is particularly important for ligaments with limited blood supply.
The following videos demonstrate how the MSR treatment system effectively targets different aspects of ankle sprain recovery. These examples showcase the significant benefits of manual therapy and how the integrated MSR approach can speed up healing and reduce the risk of future sprains.
Rehab Ankle Sprains - Exercise and Treatment
Without proper treatment and rehabilitation, a severely injured ankle may not fully heal, leading to instability. This instability can result in chronic pain, recurrent sprains, gait imbalances, osteoarthritis, and ongoing dysfunction. In this video, Dr. Brian Abelson and Miki Burton RMT demonstrate effective methods for addressing this common issue.
MSR - 7 Point Ankle & Foot Mobilization
Enhancing joint mobility is crucial for effectively addressing the entire kinetic chain, especially after an ankle sprain. In this video, Dr. Abelson demonstrates powerful MSR techniques specifically designed to improve ankle and foot mobility, which is key to a full recovery and preventing future injuries.
Facial Expansion: MSR Foot Pain Protocol
Using fascial expansions to treat ankle sprains offers a holistic approach that integrates a modern understanding of fascia's role, kinetic chain relationships, and key principles from acupuncture and traditional Chinese medicine. This method connects fascial lines with acupuncture points like ST44, LV3, LV2, K3, and B60, forming a cohesive treatment plan. We combine fascial expansions, osseous and myofascial techniques, and a functional exercise program. This comprehensive strategy addresses immediate pain and inflammation and supports long-term recovery by enhancing tissue mobility, reducing scar tissue, and restoring optimal function to the ankle and surrounding structures.
Nerve Entrapments and Ankle Sprains
An ankle sprain, especially a lateral (inversion) sprain, can also impact nearby nerves. Addressing these nerve-related issues is crucial for a full recovery.
Superficial Peroneal Nerve: This nerve is vulnerable to traction injuries during a lateral ankle sprain. If it becomes entrapped, we use specific Motion-Specific Release (MSR) techniques, combined with osseous and myofascial approaches and a functional exercise program, to release it. Properly addressing this nerve trauma is key to enhancing the overall recovery process.
Peroneal Nerve Release:
IIn this video, Dr. Mylonas demonstrates key MSR techniques used to release peroneal nerve entrapments that can occur after an ankle sprain.
Treatment Frequency
Manual therapy frequency varies based on the severity of the ligament injury:
Grade 1 Tear (Mild):
Initial: 2 times per week or 1 30-minute session per week
Duration: 1-2 weeks, transitioning to self-managed care
Total: 3 to 6 appointments, including follow-ups.
Grade 2 Tear (Moderate):
Initial: Weekly or bi-weekly visits (2 15-minute sessions or 1 30-minute session per week)
Duration: 2-4 weeks, tapering as symptoms improve
Total: 3 to 8 appointments, including follow-ups.
Surgical Cases
Most ankle sprains—around 90%—do not require surgery. In the rare cases where surgery is necessary, such as with complete ligament tears or severe instability, post-operative rehab begins with pain management and progresses through weight-bearing exercises, strengthening, and sport-specific activities, ultimately leading to a gradual return to full function.
Exercise
After the acute phase of a lateral ankle sprain, it's crucial to begin a comprehensive rehabilitation program. This should include three key components: flexibility and mobility, muscle strengthening, and balance and proprioception training. Each is vital for a full recovery and preventing future injuries.
Flexibility and Mobility: Regaining the ankle’s range of motion is essential for restoring normal function. This involves targeted stretching exercises tailored to the severity of the injury.
Strengthening: Strengthening the muscles around the ankle provides crucial support and stability, helping to prevent future sprains. Exercises will be personalized to your specific needs.
Balance and Proprioception Training: After an ankle sprain, it is key to retrain your body’s awareness of position and movement (proprioception). Balance exercises help restore this awareness, reducing the risk of re-injury.
These exercises are examples of what might be included in your rehabilitation plan, but the exact routine will be customized to fit your individual needs and injury severity.
Rehab Ankle Sprains - Exercise and Treatment
Without appropriate treatment and rehabilitation, a severely injured ankle may not fully heal and could lose its stability. This loss of stability could, in turn, result in chronic ankle pain, recurrent sprains, gait imbalances, osteoarthritis, and a path of ongoing dysfunction. In this video, Dr. Brian Abelson and Miki Burton RMT show you effective ways of addressing this common condition. (Exercises start at Time Code 08:45)
Improve Your Balance - Exercises for Beginners
Balance exercises are essential for recovering from ankle sprains and enhancing sports performance. These exercises help stabilize the ankle during functional movements, reducing the risk of re-injury. Incorporating basic balance exercises into your rehabilitation program can significantly improve stability and prevent future sprains.
Improve Your Balance - Advanced Exercise
Advanced balance exercises are valuable for all ages, particularly for those recovering from ankle sprains. These exercises enhance your ability to control and stabilize your body, reducing the risk of re-injury and improving sports performance. This routine is designed to build on the beginner series, which should be completed for several weeks before advancing.
Why Choose Our Approach for Ankle Sprain Recovery
Our comprehensive approach to treating ankle sprains consistently achieves over a 90% success rate in reducing pain and restoring full function. Here’s why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, the MSR methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring you receive top-tier care for your ankle injury.
Thorough Assessments: We conduct detailed evaluations to identify all contributing factors, including ligament damage, biomechanical imbalances, and nerve involvement, often present in ankle sprains.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely address fascial restriction and ligament injury areas, providing targeted and effective relief.
Customized Exercise Programs: We create individualized exercise plans that improve ankle mobility, strengthen surrounding muscles, and restore full function, aiding in your complete recovery.
Logical, Evidence-Based Approach: Our treatment protocols combine manual therapy, exercises, and supportive measures to offer a comprehensive and lasting solution. We set clear timelines and conduct regular re-evaluations to track progress and fine-tune your treatment plan as needed.
Choose our proven, patient-centred approach for effective, long-term relief from ankle sprains. Take the first step toward your recovery with confidence.
References:
Wolfe MW. Management of ankle sprains. Am Fam Physician 2001; 63(1): 93-104.
Effects of Tibiofibular and Ankle Joint Manipulation on Hip Strength and Muscle Activation, Lawrence MA, Raymond JT, Look AE et al. Journal of Manipulative and Physiological Therapeutics 2020; 43(5): 406-417.
Fukuhara T, Sakamoto M, Nakazawa R, et al. Anterior positional fault of the fibula after sub-acute anterior talofibular ligament injury. J Phys Ther Sci 2012; 24(1): 115-117.
Fong DT, Chan YY, Mok KM, Yung PS, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. BMC Sports Science, Medicine and Rehabilitation. 2009 Dec 1;1(1):14
Fong, D. T., Hong, Y., Chan, L. K., Yung, P. S., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports medicine, 37(1), 73-94.
Waterman, B. R., Owens, B. D., Davey, S., Zacchilli, M. A., & Belmont Jr, P. J. (2010). The epidemiology of ankle sprains in the United States. JBJS, 92(13), 2279-2284.
Hertel, J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of athletic training, 37(4), 364.
Doherty, C., Delahunt, E., Caulfield, B., Hertel, J., Ryan, J., & Bleakley, C. (2014). The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports medicine, 44(1), 123-140.
Kaminski, T. W., Hertel, J., Amendola, N., Docherty, C. L., Dolan, M. G., Hopkins, J. T., ... & Poppy, W. (2013). National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. Journal of athletic training, 48(4), 528-545.
van Rijn, R. M., van Os, A. G., Bernsen, R. M., Luijsterburg, P. A., Koes, B. W., & Bierma-Zeinstra, S. M. (2008). What is the clinical course of acute ankle sprains? A systematic literature review. The American journal of medicine, 121(4), 324-331.
Hubbard-Turner, T., & Turner, M. J. (2020). Physical activity levels in college students with chronic ankle instability. Journal of Athletic Training, 55(2), 181–186.
Martin, R. L., Davenport, T. E., Paulseth, S., Wukich, D. K., & Godges, J. J. (2013). Ankle stability and movement coordination impairments: ankle ligament sprains. Journal of Orthopaedic & Sports Physical Therapy, 43(9), A1–A40.
Han, K., Ricard, M. D., & Fellingham, G. W. (2021). Effects of a 4-Week Exercise Program on Balance Using Elastic Tubing as a Perturbation Force for Individuals With a History of Ankle Sprains. Journal of Sport Rehabilitation, 30(1), 14-20.
Thompson, C., Schabrun, S., Romero, R., Bialocerkowski, A., & Marshall, P. (2020). Factors contributing to chronic ankle instability: a systematic review and meta-analysis of systematic reviews. Sports Medicine, 50(1), 67-80.
Gribble, P. A., Bleakley, C. M., Caulfield, B. M., Docherty, C. L., Fourchet, F., Fong, D. T., ... & McKeon, P. O. (2016). Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. British journal of sports medicine, 50(24), 1496-1505.
Hébert-Losier, K., Wessman, C., Alricsson, M., & Svantesson, U. (2018). Updated reliability and normative values for the standing heel-rise test in healthy adults. Physical therapy, 98(8), 674-681.
Kim, K. M., Hart, J. M., Saliba, S. A., Hertel, J., & Ingersoll, C. D. (2011). Effects of balance training on ankle joint stiffness in adults with chronic ankle instability. International journal of sports medicine, 32(07), 577-583.
Sulowska, I., Mika, A., Oleksy, Ł., & Stolarczyk, A. (2019). The influence of plantar short foot muscle exercises on the lower extremity muscle strength and power in proximal segments of the kinematic chain in long-distance runners. BioMed research international, 2019.
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
Why Choose Our MSR Courses and MSR Pro Services?
Elevate your clinical practice with our Motion-Specific Release (MSR) courses and MSR Pro services, designed to provide a comprehensive, evidence-based approach to musculoskeletal care. Here’s why you should join us:
Proven Methodology: Developed by Dr. Brian Abelson, an international best-selling author with over 30 years of clinical experience, MSR integrates the most effective elements of osseous and myofascial therapies. With a success rate exceeding 90%, our approach helps set a new industry standard.
Comprehensive Training: Our courses blend rigorous academic content with innovative techniques. You’ll master essential areas like orthopedic and neurological examinations, myofascial treatment, fascial expansions, and osseous adjusting and mobilization.
Extensive Resources: As an MSR Pro subscriber, access a vast library of over 200 MSR procedures, fillable PDF forms, instructional videos, and in-depth articles. From patient intake to tailored exercise prescriptions, our resources equip you for clinical success.
Tailored Support: Refine your diagnostic skills and expand your treatment techniques with ongoing support through over 750 videos, including 200 technique videos, 250 exercise videos, and 160 MSK articles. This extensive library features over 50 musculoskeletal condition articles, all designed to support you in clinical practice. Our resources are dynamic, with regular updates to articles, technique videos, and new additions to our educational curriculum.
Innovation and Growth: We emphasize continuous learning and innovation, giving you the tools to adapt and thrive in complex clinical scenarios. Our courses and resources are designed to foster professional growth, keeping you at the forefront of musculoskeletal therapy.
Unlock your practice's full potential with our MSR courses and MSR Pro services. Achieve outstanding clinical outcomes and join a community of forward-thinking practitioners dedicated to excellence in patient care.
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