Fall Sports: Ankle Sprains and How to Prevent & Manage Them
You’re in the backyard, playing a game of soccer with your kids, when little Johnny fakes you out and takes off in the other direction. You try to quickly change your direction, and you step down on a loose stick. Your ankle rolls. You go down, but you think you’re good to go. You stand, and your ankle is hurting as soon as you step down. “Well shoot, I sprained my ankle,” you think as you hobble over to a patio chair. Over the next few hours, your ankle swells up and you know you’ll be couch-bound for a while. So you get to thinking: “How can I get better faster? I have to coach Johnny’s soccer game this weekend, and we have that hiking trip next week. I can’t spend two weeks on the couch with my ankle up.”
Ankle sprains are a pain (literally and figuratively), and they often show up at inconvenient times. It’s important to know if you’re at a higher risk, how to prevent a sprain, and how to manage the sprain if it does occur. Knowing all of this can help to stop the sprain from occurring before it happens, or at least make your recovery faster and easier.
At least 10 million ankle sprains occur each year, primarily in 10-19 year-olds.
2 million of those sprains require an emergency room visit, while the other 8+ million can be treated at home or with visits to a chiropractor, physical therapist, or general/family practice physician.
Risk Factors: Who is most likely to sprain an ankle?
Several factors influence your risk for an ankle sprain.
History of Prior Ankle Sprain - If you’ve sprained your ankle before, you’re at a higher risk of spraining your ankle again. Within the first year after the initial sprain, you have a 2x higher risk of spraining the ankle again. You’re also at a higher risk of developing chronic ankle instability and more frequent ankle sprains in the future. This risk is significantly decreased if you properly treat and rehabilitate your ankle.
Sports - The sports with the highest rates of ankle sprains include basketball, volleyball, soccer, lacrosse, and football. Ankle sprains mostly occur as you step down with your foot, generally when you step on an uneven surface (like another player’s foot) or when you step with too much lateral (sideways) motion.
Hip Strength - Your hip is essential for the overall stability of your leg, as it helps to create and transfer stability from your core to the rest of the leg. In particular, the strength of your hip extension (bringing your leg straight back behind you) and your hip abductors (bringing your leg up to the side) are relevant for ankle sprains. Your gluteal muscles (the gluteus maximus, gluteus medius, and gluteus minimus) are important in both of these movements.
Ankle Strength - The strength of your ankle and foot muscles is essential for the overall stability of your ankle, which might be obvious. Notably, your dorsiflexors (your shin muscles, which bring your toes up towards your shin) and your plantar-flexors (your calf muscles, which point your toes down) should be balanced in strength. Most people have weaker shin muscles, simply because we don’t use these muscles as often as our calf muscles.
Balance Ability - A lack of balance can be caused by a lack of ankle strength or a lack of proprioceptive (position) sense. Athletes who could stand on one leg with their eyes closed (without feeling unstable, touching their foot down, or moving their planted foot) for 10 seconds had less than half the risk of ankle sprains.
Age - Most ankle sprains occur between the ages of 10 and 19. This is likely because 10-19 year-olds are more engaged in athletics and generally more active than older individuals are.
Body Composition - People with a higher weight or BMI are at a higher risk for ankle sprain. This does not necessarily mean that weight loss would decrease the risk of ankle sprain, as other factors like what kind of physical activity you engage in or what position you play in a sport can be relevant as well.
How can I prevent an ankle sprain?
The best way to prevent an ankle sprain is to strengthen your ankle. We do this doing two things: (1) strengthen the muscles around the ankle, and (2) train your balance and proprioception (position sense).
Here are three exercises that help you do both (click the link for a video going over all 3):
Single Leg Balance - Stand on one foot for 30 seconds, and repeat on the other side. Do this 2 times per day. Build up to 60 seconds. (Pro Tip: do this while brushing your teeth). Once you can do 60 seconds on each leg, keep building up to 120 seconds or more! To increase the challenge, you can close your eyes (this really challenges your balance system), or stand on an unstable surface like a folded blanket, a pillow, or a wobble board. Balance exercises strengthen your ankles and feet, allowing them to respond better to situations where you’re at risk of a sprain.
Vele’s Forward Lean - Standing straight up, lean forward from your ankles as far as you can without losing your balance and without lifting your heels. Do not bend your back or hips. Hold this position for 5 seconds, then return to standing up straight. Doing this in front of a wall will help you feel stable and give you something to fall against if you lose your balance. Do 15 repetitions (holding 5 seconds each time), 2 times per day. This will help with the strength and mobility of your ankles.
Ankle Alphabet - Draw the capital letters A-Z with your does, as big as you can. Go through the entire alphabet 2 times per day with each foot. This will increase the strength and mobility of your ankle. To make this more challenging, you can use an exercise band to add some resistance.
How do I manage an ankle sprain?
Unfortunately, not all injuries are preventable. No matter how strong your ankle is, you can’t always keep it under control if you step or land on an uneven surface (like a rock, a root, or someone else’s foot).
So, you’ve sprained your ankle. What’s the best way to deal with it?
Currently, the recommended way to manage most musculoskeletal injuries is represented by this acronym: PEACE & LOVE. In the following bullet points, we’ll break this down for ankle sprains.
PEACE is for immediate management (0-72 hours after injury), and LOVE guides recovery after 72 hours and return to activity.
Protection - Avoid activities and movements that cause pain for 24-72 hours after injury. Resting for longer than 72 hours can lead to an extended recovery time
Elevation - Elevate your ankle above your heart as often as possible. The best way to do this is by laying flat and raising the injured ankle on a pillow or two.
Avoid Anti-inflammatories and Icing - Ice and anti-inflammatory medications like ibuprofen or other NSAIDs can impair healing, especially in the first few days. You NEED inflammation for your ankle to recover properly. They should only be used for pain relief if the pain is unmanageable otherwise.
Compression - Compression sleeves for the ankle and certain taping patterns can reduce pain and mitigate swelling. Elevation and Compression both decrease some of the annoyance of inflammation without totally getting rid of the inflammation needed to promote healing.
Education - Knowing about your injury and the best ways to treat it can improve your recovery. Reading this blog, watching some videos, and doing some more reading about ankle sprains are good ways to learn about your ankle sprain and how to manage it.
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Load - Using your pain as a guide, gradually start to use and put weight on your ankle. The sooner your start using the injured ankle (without increasing pain too much), your tissue will repair and recover better and more functionally. If you don’t use your ankle early, then the injured tendons and ligaments will form disorganized scar tissue, which is less mobile and less functional than the organized scar tissue that will develop if you start using it earlier.
Optimism - Confidence, positivity, and a manageable level of stress are key to recovering well. Injuries can be stressful, especially in sports where you have pressure from your coach, team, classmates, and parents. Confidence and positivity help you to recover faster, and maintaining a manageable stress level can reduce the risk of chronic pain and problems. Ankle sprains are usually quite manageable, particularly if you incorporate these PEACE & LOVE methods, early rehabilitation, and chiropractic care.
Vascularization - Pain-free cardiovascular exercise increases blood flow and promotes healing in your injured ankle. For lower body injuries like ankle sprains, arm cycling is a great option; regular biking and swimming could be good options as well, depending on whether or not they aggravate your ankle.
Exercise - After an injury, you need to be active to restore mobility, strength, and proprioception (position sense) in the injured area. Specific rehabilitative exercises can help you get back to where you were and reduce the risk of reinjury. The prevention exercises we mentioned earlier also work great to strengthen and rehabilitate your ankle. You need to rehabilitate your ankle to best reduce your risk of future ankle sprains and instability.
Exactly how long the healing and recovery process takes will depend on the severity of the initial injury, whether or not you have any flare-ups, and the steps you take to promote your health and healing. Typically, a low-grade ankle sprain will take about two weeks to heal enough to get you back to regular activity. A more severe sprain can take two or three months to get back to that point. If you take action early, your recovery time will tend to be shorter and it will be easier for you to get back to your normal activity.
Final Thoughts on Ankle Sprains
Ankle sprains are incredibly common and incredibly annoying. As with any condition, if you know how to treat it right after the injury occurs, you will likely recover faster and with fewer issues. Following the PEACE & LOVE recommendations and training your ankles consistently are both ways to help ensure a good recovery.
At Northbound Chiropractic, we work with you through your injury. We can guide you along the way, providing appropriate soft tissue, chiropractic, and nutritional treatments to promote healing and recovery.
If you or a family member is dealing with a sports injury or wants to maximize their performance, call us at 763-373-9710 or schedule online here!
Wishing you the best,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties