All About Ankle Sprains

Starting pitcher Eduardo Rodriguez has been a force to reckon with on the mound, even among a rotation of pitchers who have dominated this season. But after pitching five scoreless innings against Toronto a few weeks ago, Rodriguez landed on the disabled list with a severe ankle sprain sustained in a collision with another player. With negative x-rays, the pitcher still found himself sidelined with an all too common injury.

BIDMC’s Christopher Miller, MD, and Brianna Whitehouse, PA-C, from the Foot and Ankle Center, share insight to the treatment and recovery of ankle sprains.

What is an ankle sprain?

A sprain is a soft tissue injury to the ankle. The most common type of ankle sprain is a “low ankle sprain,” which occurs when the ankle rolls outward. Ligaments—the strong bands of tissue that connect one bone to another—are either stretched or torn during a sprain. This can cause pain and instability.

Rodriguez’s sprain is somewhat unique, in that he seems to have sustained a medial ankle sprain (inward roll) rather than a lateral ankle sprain (outward roll). The Boston Globe captured his injury in a photo that shows how the majority of the stress was on the inside of his leg.

How easy or difficult is it to sprain an ankle?

The ankle is a fascinating and complex joint that allows us dexterity to perform a wide array of athletic motions. It is also subject to incredibly high forces during activity, putting the joint at high risk for injury. Sprains are the most common athletic injuries we see. Almost everyone has sprained their ankle at some point in their life.

Patients are often shocked by how painful it can be when they have a severe sprain. Many times they are unable to walk and have significant swelling.

How quickly can someone recover?

There are different levels of ankle sprains. The first – a mild lateral ankle sprain – can usually recover in a couple of days. There may be some soreness and swelling but it heals because there is minimal, if any, true ligament injury or instability.

Moderate, or grade 2, ankle sprains are the most common type we treat at our center. These are associated with tearing of the ligaments and significant swelling. Most of the time, patients can walk and bear weight, but with difficulty. The key for these patients is to avoid over-treating the ankle sprain with prolonged (weeks or months) rest and immobilization. A short course of RICE therapy (Rest, Ice, Compression and Elevation) is important, followed by supportive bracing and physical therapy. Recovery typically takes 2-4 weeks for routine activities but there may be some discomfort for 3+ months.

Finally, a severe, or grade 3, sprain is associated with extensive soft tissue injury to the lateral ankle. Often, the patient is unable to bear weight at all due to pain. We routinely cast these patients for 10-14 days which usually provides extensive relief after the brief course of rigid immobilization. We will then transition the athlete to a walking boot or brace, and begin physical therapy as soon as possible. Recovery from these injuries can vary, but can take up to 6 months before maximal recovery.

What risks does an athlete face in overall ankle health after suffering a sprain?

Following an ankle sprain, an individual’s sense of balance and coordination of the ankle may be impaired. This sensory deficit, in combination with post-injury ankle stiffness, can lead to decreased agility during the recovery period.

The severity of the sprain truly determines any long-lasting effects on the ankle health. Early treatment is critical, but there may be persistent dysfunction for months. In up to 20% of patients, there may be persistent pain or instability of the ankle. Chronic ankle instability can be devastating to an athlete’s career and may necessitate surgery to reconstruct the injured ligaments.

What’s the likelihood that you can sprain your ankle again?

In general, the risk of re-injury following a sports injury is high. This is particularly true when an athlete returns to play too early. Unfortunately, there is little evidence to guide physicians about when an athlete is safe to return, but coordination with a coach or trainer is necessary to determine when the individual has progressed far enough to allow for safe play.

Are there ways to prevent re-injury?

Early rehab will focus on strengthening the dynamic stabilizers of the ankle, which are the muscles on the lateral (outside) part of the lower leg and calf. This helps to stabilize the ankle while the ligaments are healing in place. Exercises will focus on progressive strengthening, beginning with theraband strength training and progressing to balance and plyometric exercises, and finally sport-specific drills as the athlete improves.

Can taping your ankle prevent future injury?

Taping is an excellent way to immobilize the ankle as an athlete returns to training and competition. Eventually, we hope that the physical therapy and strengthening will progress to the point that external support is not needed. However, some sports are high-risk for recurrent ankle sprains. In basketball, you may see many players competing in ankle braces to prevent future injury.

Learn more about the Foot and Ankle Center. Call 617-667-3940 to make an appointment with Dr. Miller.