Ankle sprain: why many athletes get injured again within 12 months

An ankle sprain is often seen as a trivial injury. It happens during a match, a run, a training session or simply by putting the foot down badly. After a few weeks the pain decreases, the swelling goes down and many people go back to their usual activities convinced the problem is completely resolved.

The reality is different.

Statistics show that a significant proportion of athletes and recreational sportspeople suffer another sprain within a year of the first episode. In some cases the ankle keeps giving way, in others a feeling of instability or lack of confidence appears during changes of direction, jumps or running.

Understanding why this happens is essential in order to reduce the risk of recurrence and return to sport more safely.

One of the most common mistakes is to consider an ankle healed simply because it no longer hurts.

Pain is only one of the elements to assess.

After a sprain, changes that are not noticed straight away can persist:

• reduced neuromuscular control
• loss of balance
• proprioceptive deficits
• reduced strength
• changes in the way you walk or run

This is why physiotherapy after an ankle sprain should not end when the pain disappears, but when function has been fully recovered.

Most sprains occur in inversion.

In practice the foot turns inwards excessively, putting the lateral ligaments of the ankle under stress.

Depending on the severity of the trauma, the following may occur:

• ligament strains
• partial tears
• complete tears
• swelling and inflammation
• changes in joint control

Beyond the mechanical damage, the injury also affects the nervous system and the body's ability to sense the position of the joint.

It is precisely this aspect that explains many recurrences.

Proprioception is the body's ability to recognise the position of the joints in space.

When a person walks, runs or jumps, the nervous system continuously receives information from muscles, tendons and ligaments.

After a sprain this system can become less efficient.

The consequence is that the ankle reacts more slowly to the unexpected.

For example:

• an uneven step
• a change of direction
• an irregular surface
• contact during sport

can become harder to handle.

In physiotherapy after an ankle sprain, proprioceptive rehabilitation is one of the most important components.

Recurrences rarely come down to bad luck.

Very often there are factors that increase the risk of another sprain.

Among the most common are:

• returning to sport too early
• incomplete recovery of strength
• balance deficit
• loss of mobility
• insufficient motor control

An athlete can feel fine in everyday activities but not yet be ready for the specific demands of their sport.

This difference is often underestimated.

When people talk about the ankle, many think exclusively of the ligaments.

In reality stability is the result of several structures working together.

The following come into play:

• ligaments
• muscles
• tendons
• nervous system
• motor control

Even with adequate ligament healing, a poor muscular response can increase the risk of new traumatic episodes.

That is why physiotherapy for an ankle sprain cannot be limited to managing swelling or pain alone.

After a sprain it is common to see a reduction in strength.

This can affect not only the ankle, but also structures further away.

In many cases the following are involved:

• calves
• peroneal muscles
• tibialis posterior
• glutes
• hip muscles

If these structures do not recover properly, movement becomes less efficient and the risk of compensation increases.

Many athletes use the return to walking as a measure of their recovery.

In reality there is an enormous difference between walking without pain and coping with:

• sprints
• changes of direction
• jumps
• landings
• sudden accelerations

Sport demands far greater reaction speed and control.

This is why the final phase of rehabilitation is of fundamental importance.

Proprioceptive exercises are often associated with wobble boards or soft cushions.

In reality the work is much broader.

The aim is to improve the nervous system's ability to react quickly to changes in the ground and to outside disturbances.

The following are progressively introduced:

• single-leg exercises
• dynamic work
• changes of direction
• sport-specific drills
• complex tasks

This kind of training helps the ankle regain confidence and the ability to adapt.

When a sprain is not properly rehabilitated, persistent problems can appear.

Among the most common are:

• a feeling of giving way
• instability while running
• difficulty with changes of direction
• recurring pain
• fear of movement

In the long term these changes can also affect the knee, hip and spine.

The body tends in fact to develop compensation strategies to protect the joint it perceives as less safe.

Every athlete has different characteristics.

There is no single protocol that suits everyone.

A complete assessment makes it possible to analyse:

• joint mobility
• strength
• balance
• motor control
• quality of the sporting movement

This information makes it possible to build a personalised programme and to identify the factors that could encourage further sprains.

At TI-FISIO in Mendrisio, recovery after a sprain is not limited to the initial phase of the injury.

The aim is to support the patient all the way to the recovery of function.

The programme may include:

• pain management
• recovery of mobility
• muscle strengthening
• proprioceptive work
• progression towards sporting movements

The approach is adapted to the characteristics of the person and to the level of activity they take part in.

One of the most delicate phases concerns the return to activity.

Many athletes tend to speed things up as soon as they feel an improvement.

However, a progression that is too fast can expose the ankle to loads beyond what it can handle.

The return should be built gradually, assessing:

• response to load
• quality of movement
• neuromuscular control
• tolerance to exercise

This makes it possible to reduce the risk of recurrence and increase safety.

Two people with the same injury can have very different needs.

A runner, a footballer, a rugby player or a sedentary person place completely different demands on the ankle.

This is why rehabilitation must be personalised.

The aim is not simply to heal the ligament.

The aim is to bring the individual back to the desired level of activity in the best possible condition.

Many athletes who have already had a sprain live with the belief that sooner or later it will happen again.

In reality the risk can be reduced significantly.

When the following are restored:

• strength
• balance
• mobility
• motor control
• the ability to adapt

the likelihood of another sprain drops considerably.

Correct physiotherapy after an ankle sprain makes it possible to address not only the immediate consequences of the injury, but also the factors that encourage recurrence.

This is why the real challenge is not only to get back to playing, running or training.

It is to do so with an ankle that is more stable, safer and better prepared for the demands of sport and everyday life.

+41 91 940 10 20

info@ti-fisio.ch

Via Ceresio 42, Pregassona.

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