The Underlying Causes Of Ankle Sprains

Some people go a whole lifetime of sport and recreation with no rolled ankles, no sprained ankles, and no ankle pain. At the other end of the spectrum are those who have stubborn ankle pain, punctuated by repeated, dramatic, slow healing ankle sprains. The good news is that very few cases of ankle pain can be attributed to random bad luck and that in most instance the underlying causes of ankle pain are very identifiable and very manageable. 

History of Previous Sprained Ankles

Both research and clinical experience have shown over the years that you are at a significantly higher risk of suffering from ankle sprains if you have had sprained ankles in the past. It has also been suggested that slower recovery times from sprained ankle episodes are more prevalent in those who have suffered from multiple sprained ankles. This may be especially true for those who have not been through rigorous rehabilitation processes after previous sprains. 

There are multiple changes that can occur after a sprained ankle takes place that could potentially influence future sprains. Scar tissue formation, loss of muscles mass and loss of motor control at the ankle joint are all serious candidates for creating a predisposition towards further sprained ankles. It must also be considered that the initial ankle sprain itself may not have been random; and that the underlying factors which caused sprain number one may be ongoing. 

Activity Type & Activity Levels

Our bodies permanently live within a dynamically shifting need for movement and rest. When we are in recovery from injuries like broken bones and sprained ankles the balance shifts decisively towards rest. The closer we are to the sprained ankle moment itself the more rest is appropriate during recovery. As we progress with the healing process towards full recovery of our sprained ankle the balance shifts gradually back towards activity. 

If you have a severely broken femur bone it is pretty easy at first to know what to do, that bone cannot bear weight until it begins to knit either by Itself or with surgical assistance. Knowing how much to rest and how much to move during recovery from a sprained ankle however is an art, there are no hard and fast rules. There are a growing number of people (myself included) who believe that we should err on the side of ‘movement within reason’ during every phase of sprained ankle recovery. This belief is however not an endorsement of early returns to sport and exercises. Overdoing it can massively increase recovery time of sprained ankles and even put them literally back to square one. 

In the same way that the broken bone needs rest,  sprained ankle ligaments need rest in order to effectively knit themselves and achieve full recovery of tissue strength. Early resumption of safe movement within the sprained ankle itself and its supporting tissues is king. Early return to controlled doses of weight-bearing is encouraged during recovery. Risk comes in with overuse and with use under less controlled conditions. 

A great example of proactive but cautious use in the later stages of recovery is when we start running gently in straight lines on even ground as a form of exercise. In contrast, if we jump the gun and return to activities that involve significant changes of direction or go straight to activity on uneven surfaces we risk increased recovery time. 

There is a golden rule that helps prevent overuse and inappropriate use of the ankle while sprains are healing. If you have some moderate pain during or for a short time after a resumed activity that’s generally okay and may even be a good thing. If you have a very significant increase in pain after an activity,  meaning if the pain it causes is extreme or because it stays aggravated for days after that activity…… stop! Any activity that causes a significant aggravation of the symptoms is one to back off from and return to later. ALWAYS TAKE PROFESSIONAL ADVICE WHEN MAKING THESE KINDS OF DECISIONS! 

Overall Strength of Your Ankle & Leg

The human ankle has very minimal ‘local’ muscle support, that’s why it is such a boney piece of real estate. Your wrist is in the same boat, it is, in fact, the muscle group at your elbow that sends strong tendons down to the wrist to provide support. 

The strength in the larger muscles groups of the leg ( in the thigh and hip area ) are the primary support for the ankle joint and ankle ligaments whether they are recovering from a sprain or not. In addition, some of the smaller muscles along the outside of the shin have a role to play in injury prevention. 

It stands to reason that if the major support muscles are not functioning we may find that recovery time of our sprained ankle is affected. Reduced support usually means increased stress and increased stress can mean slower healing. 

Genetic Makeup

There are numerous genetically influenced variables that may affect the likelihood of you suffering with sprained ankles/rolled ankles. If you were born with flat feet this can predispose you to sprained ankles. Having flat feet is like being born with poor shock absorption because the arch of the foot is essentially a shock-absorbing mechanism that is missing. 

Being born with high arches is also a risk factor for sprained ankles/rolled ankles. High arches can create instability in the ankle which overtime may weaken the connective tissues, including ligaments. It is also the case that some of us are born with more ‘ligament laxity’ than others. If you have slightly rubbery ligaments they are possibly more prone to twisting, rolling and becoming sprained in and around the ankle

Hard Surfaces

A seldom spoken truth is that concrete is about as hard on our connective tissues as sugar is on our teeth and our waistlines. Concrete and paving slabs by virtue of their extreme hardness and flatness have no equivalent environment in all of nature. Even baked dry river beds and salt flats while being flat have a lot more give. Rocky terrain may be as hard as concrete but it is generally uneven in the extreme and not a terrain upon which your ancestors would have heel struck. In other words, we didn’t evolve to live on hard flat ground. 

If you spend a great deal of time standing on or moving on hard flat surfaces it is hard in your connective tissues and on your muscles. Examples include working in hospitality and being a road-based distance runner, both of which can create a build-up of microtrauma in the ankle. A build-up of microscopic stress over time that may not make itself known until you suffer a rolled ankle. 

Closing Thoughts

The influencing factors on recovery time after a sprained ankle/rolled ankle are complex and interdependent. If you don’t feel like you are progressing it may be time to seek professional help. If you do seek help,  expect to see clear and decisive gains to confirm that your practitioner is giving you what you need to speed your recovery. 

The fall out from a single significant ankle sprain left untreated and unrehabilitated can be life-altering. The implications of unattended muscle wasting after a period of immobility and the resulting muscle wasting have the capacity to breach the gap between a simple sports injury and chronic pain & disability later on. One small reflection of this fact is the dramatically increased risk of further sprains that sprained ankle sufferers have. The fact of the matter is that our lifestyles aren’t usually active enough in the right ways to guarantee full autonomous rehabilitation of a sprained ankle. This is where rehabilitation and prevention exercises come into play.  Like so many things in life sprained ankle repair and prevention often require a willingness to embrace hard work