Massage therapy · Kitchener–WaterlooInversion Sprain of the Ankle

There are three main ankle ligaments that can be affected during an ankle sprain: the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). All three ligaments are located on the outside of the ankle where the main bony bump is. When you roll over the outside of your ankle, the ligaments at the side can be sprained or, in severe cases, torn.

Ankle sprains are more common in children and in females (Doherty et al., 2014). Poor balance and ligaments that are too loose or flexible are also risk factors (AAOS, n.d.). Children also tend to throw themselves into sport and often have tumbles and falls.

Certain sports are also more prone to problems. Indoor and court sports carry the highest risk (Doherty et al., 2014), and sports that involve cutting, jumping or twisting, such as netball, basketball or field sports, are where problems can occur. Wearing shoes that do not give the foot and ankle enough support also increases the risk (AAOS, n.d.).

Sports on uneven ground can also be problematic, especially fields that are poorly maintained. It is easy to step into a pothole and sprain the ankle during sport.

How to Treat an Inversion Sprain of the Ankle:

After the first few days, restoring movement, strength and balance is a key part of recovery, because incomplete rehabilitation is the most common cause of long-term ankle instability after a sprain (AAOS, n.d.). I can treat mild and moderate sprains directly, and after a severe sprain or a broken bone I support your doctor's plan. See the My Approach tab for how I work.

1. Protect and Rest

For the first 2 to 3 days, the NHS recommends PRICE: protect the injury (for example with a support), rest it, use ice, wrap a bandage around it to support it during the day (compression), and keep it raised on a pillow (elevation) (NHS, 2024). Avoid all sport. Early weight-bearing, as far as you can comfortably manage, is usually recommended (AAOS, n.d.). Gentle walking is fine if you can, but if you cannot, use one or two crutches. To help prevent swelling, avoid heat (such as hot baths and heat packs), alcohol and massage for the first couple of days (NHS, 2024).

2. Ice

Wrap an ice pack (or a bag of frozen vegetables) in a tea towel and apply it for up to 20 minutes every 2 to 3 hours (NHS, 2024). Never put ice directly on the skin. In most cases the worst of the swelling and pain lasts 2 to 3 days (AAOS, n.d.), but severe sprains can take months to get back to normal (NHS, 2024).

3. Pain Relief

The NHS (2024) suggests speaking to a pharmacist, and says that at first you can try paracetamol to ease the pain and ibuprofen gel, mousse or spray to bring down swelling, with ibuprofen taken by mouth if needed. (This medicine information comes from the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

4. Movement Restoration

When you can move the ankle without pain stopping you, keep moving it so it does not become stiff (NHS, 2024). Slowly build up how much weight you put through the ankle during the day. I'll guide you through gentle range-of-movement exercises (see the My Approach tab).

5. Strengthening, Balance, Endurance and Agility Exercises

Balance (proprioception) training is important, because poor balance often leads to repeat sprains (AAOS, n.d.). I'll build a strength, balance, endurance and agility programme with you (see the My Approach tab).

Above all, make sure you finish your rehabilitation, so that full mobility, strength and balance are restored to the ankle. Incomplete rehabilitation is the most common cause of long-term ankle instability after a sprain (AAOS, n.d.).

On returning to sport, it may be advisable to wear an ankle brace or tape to give your ankle extra support (AAOS, n.d.). Bracing combined with an exercise programme can help prevent repeat sprains (Vuurberg et al., 2018). I can tape your ankle and show you how to tape it yourself, and help you work out which brace you need. Don't become reliant on it, as you should also train your muscles to get stronger around the ankle.

Warning signs: call 911 or go to the emergency room at your nearest hospital if you heard a crack when you were injured, the ankle has changed shape or is pointing at an odd angle, it is numb, tingling or has pins and needles, or the skin around it looks blue or grey or is cold to touch, as you may have broken a bone (NHS, 2024). A severe sprain can look very like a broken bone, so also get your ankle checked if you cannot put weight on it or it stays swollen or painful for several weeks (AAOS, n.d.).

Options outside my scope

• Walking boot, brace or cast: for more severe sprains, a doctor may recommend a removable walking boot or brace, or occasionally a short leg cast (AAOS, n.d.).
• X-ray or MRI scan: imaging may be used to rule out a broken bone or damage to nearby tendons and cartilage (AAOS, n.d.).
• Surgery: rarely needed; it may be considered when the ankle stays unstable and painful after months of rehabilitation (AAOS, n.d.).

How I can help (see the My Approach tab)

• Hands-on work and movement exercises to ease swelling and stiffness
• Strength and balance training to help prevent repeat sprains
• Taping, which I'll show you how to do yourself, and help choosing a brace

I start by assessing how your ankle and foot move, your ligaments, strength and balance, and how you walk.

If the ankle stays swollen or painful for several weeks, or keeps giving way despite rehabilitation, see your family doctor or nurse practitioner.