Intro

The sprained ankle (which usually involves the ankle ligaments) is without doubt one of the most common of all sports injuries read here.. In fact ankle ligament sprains are so common that many ankle sprains don’t even occur playing sport, the sports injury that can happen without even playing sport!! Sprained ankles can happen surprisingly easily for some of us while others go a lifetime without one. Many of you who sprain an ankle ligament and require treatment find that all you needed to do was miss a step, or possibly have your weight land awkwardly on some uneven ground. 

The ankle in many ways is quite a miraculous mechanism when you consider that your entire body weight slams (slam is no exaggeration) through the delicate ankle bones at speed several million times a year. Not only are the bones of the ankle quite delicate compared to their role in life, there are no large muscles at the ankle to prevent sprains, as there are in the shoulder or knee for example. 

The secret to the ankles success in weight bearing are the big strong ankle ligaments, but also the muscles of the hip and knee which assist the ankle in sustaining alignment during weight bearing. These are the mechanisms that prevent ankle sprains and ankle pain.

support structures that prevent ankle sprains

The ankle relies heavily on muscular and ligamentous support for its stability.

It is these strong ankle ligaments that most often bear the brunt of ankle injury in the form of ankle sprains and it is most often these ligaments that hold the key to ankle pain relief and healing from your ankle sprain. 

 

How to Treat Ligament Damage After an Ankle Sprain 

The first order of business when you sprain your ankle is rest and support to the degree that you need it, like this type of thing ankle support research.. Treating and protecting the actual physical trauma to the ligament after an ankle sprain is the primary concern in the ‘Acute Phase’ of care. Beyond this initial phase of severe swelling and pain, the imperative is to be active and pursue both agrressive (in a nice way) treatment and rehabilitation.

At one end of the ankle sprain spectrum there are mild ankle sprains which involve microscopic damage to the ligaments, at the severe end of the ankle sprain spectrum you have suffered a major ligament rupture. Where you sit on this ankle ligament sprain spectrum will to a large degree dictate the amount of treatment your ankle sprain requires, the timing of treatment your sprained ankle requires and to some degree even the type of treatment your ankle requires. 

 

3 Keys To Effective Treatment –

 Ankle Mobilisation

You  don’t need me to tell you that running half marathons with a freshly sprained ankle is not the way to go. But if you interpret this to mean that zero movement is desirable you may have gone too far with the logic. 

General mobilisation of the ankle joint is one of the 3 major keys to effective treatment of ankle ligament sprains, but so is rest. The topic of ‘mobilisation’ vs ‘rest’ and ‘immobilisation’ after injuries and sprains is a very important topic for anyone with a bad ankle sprain they need to get to grips with.

Firstly let’s be clear that ‘weight bearing’ in the immediate window after a bad ankle ligament sprain is sometimes neither appropriate or possible due to pain and ankle instability, you have damaged the stabilising ligaments after all. There is however a world of difference between bearing your full body weight through your freshly sprained ankle and the type of small gentle mobilisations that do benefit the ankle at almost any stage of the ligaments healing process. 

Many people report much faster recovery even from bad ankle ligament sprains when they choose to mobilise the foot and ankle from days or even hours after their ankle injury.

Movement is a key concept in the best ‘treatment mindset’ for ankle sprains. When we are receiving treatment for the very worst ankle ligament sprains this can literally mean drawing circles that are a few mm in diameter with the tip of their big toe for 5 minutes every half hour.. even while you are still in the non weight bearing with leg elevated phase of care. 

Small (or even tiny) movements encourage a wee bit of blood and fluid movement through the sprained ankle ligaments, override pain signals and encourage healthy repair. As the days go by the movements should gradually increase in frequency and size. 

There have been some truly monumental research efforts that support the use of ankle mobilisation for ankle sprains like this..

 

Blood Flow 

The bodies repair processes rely heavily on the supply of fresh nutrients and the evacuation of molecular waste from injury sites; this is the process you are observing when you see a swollen ankle sprain.  It is essentially common knowledge that working to maintain and increase blood flow in injured body parts like sprained ankles is a cornerstone of care. 

blood flow after ankle sprains

Blood flow – essential to healing and recovery from ankle sprains.

In the early treatment stages of healing an ankle ligament sprain the body generates a massive inflammatory response, which in bad sprains is recognisable as swelling. The extra blood is the bodies very own and very best treatment for an ankle sprain. 

All the extra blood at the site of the ankle ligament sprain serves the dual purpose of sending repair cells and repair molecules to the injured site and creating a natural splint of dressing which immobilises the area. To understand physical repair mechanisms like this one it is necessary to remember that every cell in the human body thinks that it is part of a hunting & gathering organism. The cells of your body did not get the memo about the agricultural revolution, let alone the industrial, technological or healthcare revolutions. 

Swelling is a band aid that you might not need as badly as your body thinks. When you have a bad ankle ligament sprain requiring treatment the swelling can be quite shocking. The body generates this massive swelling to immobilise the ankle partly because it is concerned you may need to keep moving to stay alive / get back to your cave / look after a child / find water.  As a hunter gatherer with a badly sprained ankle that you sustained after being attacked by a vicious gang of honey badgers you might need to keep moving!!!! The swelling that surrounds the sprained ankle acts as a kind of field dressing, think how similar a big ballooned and swollen ankle is to one that is wrapped in bandage. 

Luckily we are able to take it so much more safely and easily when we are injured these days, that’s why part of the best treatment for ankle ligament sprains is  designed to speed up clearing of all this swelling. 

Early phases of the best ankle sprain treatment plans are partly geared towards the promotion of blood flow. Elevation of the ankle assists with the easy return of blood to the heart. Small movements encourage and promote healthy circulation. The use of ice and heat create dilation and construction of blood vessels which forms a pumping action.  This being said there is no conclusive evidence yet for the use of ice and heat for ankle sprains. read here..

 

Treat the Scar Tissue 

Scar tissue is part of the bodies ‘final solution’ to ankle ligament sprains. Scar tissue is a normal, healthy part  the bodies repair mechanism and in itself has the same basic idea as the ligaments themselves. Both ligaments and scar tissue are forms of ‘fibrous reinforcement. As we have seen in the instance of swelling however, when it comes to ankle ligament sprains it is possible to have too much of a good thing. It is also quite possible to have not quite the right kind of good thing.

scar tissue can prevent full recovery from ankle sprains

Tight, disorganised scar tissue is a major issue after many ankle sprains.

 Your bodies tissues cells think you live in the big outdoors, and that is the life you are most certainly designed for. Bearing this in mind, my hypothesis on scar tissue problems in modern humans is as follows. If you live in a world where bears are a real threat to your survival and water doesn’t come out of taps it’s likely that you will be moving around a lot more than modern humans do, in virtually every stage of trying to heal your sprained ankle ligament. On top of the sprained ankle being more active it would have also been on uneven ground the whole time, uneven ground forces a huge amount of ‘movement variety’ into both sprained and unsprained ankles. 

Under ‘big outdoors’ conditions, the constant and varied movement of the ankle would lead to very flexible scar tissue build up. When you live on homogenous flat urban surfaces bound up into modern footwear I believe you develop tight knotted scar tissue after ankle sprains. I suspect there are other complex dimensions to sprained ankle healing that are severely impacted by the urban world also. Time and research may tell that story eventually.

I believe that this tight knotted scar tissue is a major issue in healing many sprained ankles. Luckily I get the chance to test this theory on a daily basis in my clinic. In the late phases of sprained ankle healing and also with stubborn unresolved sprains I use mobilisations and scraping techniques to break up and mobilise scar tissue caused by ankle sprains…. and it works!!!! I am not the only one to find this kind of success read here..

Conclusion

Ankle sprains are no joke! Research has shown that ankle sprains are strongly associated with shortened sporting careers research link... I frequently see people with shockingly long and severe histories of pain that relate to ankle sprains.

Managing the early time window with ankle sprains effectively (as we have outlined) in the first instance, and progressing to very focused and somewhat longer term rehabilitation is the best chance you have to recover and prevent re-occurence. This is a worthwhile venture as the majority of ankle sprains do re-occur.

I am sure you will agree that life is already complex and difficult enough without letting simple issues like ankle sprains cause longer term issues when it is so easily avoided.