Ankle sprains can be annoying, scary, painful, and sometimes limit your exercise for months at a time. In this article, we will discuss inversion ankle sprains, commonly called ‘rolling your ankle’. This injury ranges from a momentary slip that causes no pain or injury beyond a few seconds of shock, all the way to a traumatic injury when you can break bones and tear ligaments.

Why Does my Ankle ‘roll over’ all of the Time?

The ankle is a joint where the tibia and fibula (shin bones) attach to the talus, which is a bone in your foot. This joints main planes of movements are dorsiflexion (toes reaching to the sky) and plantarflexion (going on your toes like a ballet dancer). However, the ankle can also go into inversion (sole of foot faces the other foot) and eversion (your shin bone goes toward the opposite foot). An inversion injury is when we roll your ankle beyond the ‘normal’ range of motion, putting too much strain on the ligaments on the outside of your ankle.

Lateral Ankle Ligaments

The ligaments at risk on the outside of your ankle are the ATFL (anterior talofibular ligament), CFL (calcaneofibular ligament), and the PTFL (posterior talofibular ligament). These ligaments are strong and support your ankle and prevent it form dislocating. In a band lateral ankle sprain, either one or a combination of these ligaments can either sprained (pulled) or ruptured (torn). If all of these ligaments are torn then it usually results in an ankle dislocation.

Bone Injuries after an Inversion Injury

Although the ligaments are at risk after an inversion injury, a bony injury may also occur. A common injury as a result of an ankle sprain is a fibular fracture, often termed a ‘Weber Fracture’. This is usually as a result of significant force placed on the ankle, or an injury to an older person with lower bone density. Although surgery isn’t always the treatment, a period of immobilisation is often expected. Another bony injury that may be present is a talar dome fracture. This is a fracture of the talus which is the bone in the foot that the tibia (shin bone) sits on.

What do I need to focus on to help mitigate future ankle sprains:

1. Muscle Strength: Looking at your calf, hamstring, and quad strength is really important. When someone has suffered multiple ankle sprains, they often fear fully using that leg, and strength may reduce over time and now you have one leg that is much more resilient than the other. Double leg exercises like leg presses and deadlifts are effective for overall strength, but you really need to train with single leg exercises like single leg calf raises and single leg squats.

2. Plyometrics: To reduce your risk of injury, you need to be confident jumping and landing on both legs and on a single leg. Plyometric training needs to contain both low amplitude training (ankle-focused) and high amplitude plyometric training (knee and hip-focused). Eventually, this training needs to contain movements in all 3 dimensions of movement: sagittal, frontal, and transverse planes, as this is what is required during sports and exercise.

3. Balance and Proprioception: Although standing on a Bosu ball is very common in rehab, it is old-fashioned and doesn’t represent real life. If your sport requires you to stand on a Bosu ball then go ahead, but real like requires you to manage altering loads on a stable surface. This involves the use of resistance and weights which is moving and challenging your single leg proprioception and balance.

If you have any questions on whether physio is the best option for you, or you have any questions about MVMNT in general, feel free to contact via email.

- Jay Towolawi, Specialist Sports Physiotherapist and MVMNT Founder.