Understanding ankle sprains: Part 1

Clare Lawson • November 18, 2024

What is an ankle sprain and how to fix it? Read on below

What is a sprained ankle?

Commonly known as a ‘rolled ankle’, an ankle sprain is an acute injury that occurs when your foot twists beyond its normal range of movement. This is often very painful and causes pain, bruising and swelling around the ankle joint.

Most ankle sprains cause damage to the ligaments in your ankle, which are the structures that connect the bones together and provide stability. The ligaments can either get stretched, like a rubber band or torn.

Types of ankle sprains
Depending on what position your foot was in when you injured yourself, or what way the ankle twisted, will determine which ligaments have been damaged. There a 3 main types of ankle injuries:

1. Lateral Ankle Sprains
These are the most common, when your foot twist inwards (inversion) damaging the ligaments on the outside of your ankle. There are 3 ligaments on the outside of the ankle: Anterior Talofibular Ligament (ATFL), Calcaneofibular Ligament (CFL) and the Posterior Talofibular Ligament (PTFL).


2. Medial Ankle Sprains
These are less common than lateral ankle sprains and occur when your foot twists excessively outwards (eversion), causing pain to the inside of your ankle. The deltoid ligament is the primary ligament on the inside of your ankle that can get damaged.

3. High Ankle Sprain (Syndesmosis)
These are also infrequent but usually more severe. This injury affects the ligaments that sit at the top of your ankle, connecting the tibia and fibula bones together.
Symptoms of a syndesmosis injury are pain and swelling across the front of the ankle joint and the outer part of the ankle.

It is important to see a physiotherapist for a full assessment to determine what type of ankle injury you have and the severity of it.

Signs and Symptoms of Ankle Sprains
 
The most common signs and symptoms are:
1. Pain – Pain around the ankle bones that is often intense and occurs immediately after the injury
2. Swelling and bruising – These can happen immediately after the injury or over the next 24 hours.
3. Pain with walking, or being unable to walk or put weight through your foot. If this is the case, then you may need an x-ray of your foot and ankle to rule out a fracture.
4. Feelings of instability or giving way – it is common if the ligaments have been damaged to feel like your foot and ankle may roll again. If this is the case then you need to get physiotherapy to address this.


Physiotherapy Treatment for Ankle Sprains

The physiotherapy journey for ankle sprains begins immediately after your injury:
1. Protection: In the early stages we want to protect the injury, by following the ‘PEACE & LOVE’ guidelines – for more information, see our blog on this here.
2. Immobilisation: Depending on the severity of your injury, you may need a CAM boot, ankle brace or strapping, or all of these to help in your recovery.
3. Dry needling: This can help to reduce pain, swelling, inflammation and muscle spasm after your injury
4. Exercises: This is a crucial part of ankle sprain management. Your physiotherapist will give you exercises to help your walking return to normal, as well as exercises to restore your range of movement, strength, balance and stability to get you back to your pre-injury function.



All ankle injuries need physiotherapy to help restore the full function of the foot and ankle. Have you hurt your ankle? Book in  here to get an assessment from our experienced sports physiotherapist.



  1. Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. British Medical Journal, 326(7386), 417.
  2. Bleakley, C. M., O'Connor, S. R., Tully, M. A., Rocke, L. G., Macauley, D. C., & McDonough, S. M. (2012). Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ, 344, e3042.
  3. Delahunt, E., Bleakley, C. M., Bossard, D. S., Caulfield, B. M., Docherty, C. L., Fourchet, F., ... & Gribble, P. A. (2018). Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium. British journal of sports medicine, 52(20), 1304-1310.
  4. Doherty, C., Bleakley, C., Delahunt, E., & Holden, S. (2020). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. British Journal of Sports Medicine, 54(11), 621-626.
  5. Fong, D. T., Hong, Y., Chan, L. K., Yung, P. S., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Medicine, 37(1), 73-94.
  6. Kerkhoffs, G. M., Kennedy, J. G., Calder, J. D. F., & Karlsson, J. (2021). Ankle syndesmosis injuries: diagnosis and treatment. Journal of Orthopaedic & Sports Physical Therapy, 51(3), 103-116.

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How to Best Manage Your Acute Injury

By Clare Lawson • October 30, 2024
For decades we have been told to ‘RICE’ after we get an injury, but it’s time to let go and make room for some ‘PEACE & LOVE’. This new acronym has replaced the old ‘RICE’ acronym and it has some significant changes, including avoiding ice and anti-inflammatories after an injury as these have been found to disrupt the natural healing process that we want to occur. It also gives us more guidance on what to do after the initial injury phase, a crucial step that was missing from the old ‘RICE’ acronym. For the first few days after an injury, give them some ‘PEACE’ P: Protect We want to protect the injury by de-loading and reducing movement for the first 2-3 days to prevent further damage and allow the healing process to occur. Prolonged rest can in fact lead to longer recovery times. E: Elevate Try to keep the injured limb elevated higher than the level of your heart; this will help to reduce swelling out of the area. A: Avoid anti-inflammatory modalities It is now recommended to avoid taking anti-inflammatories, such as ibuprofen and aspirin in the first few days after your injury as these can interfere with the inflammatory process and slow down tissue healing. Applying ice to an injury may also disrupt this process; it can be still be used to assist with pain relief. After the first few days heat can also be used for pain management. C: Compress Compression of the injured area using bandages or tape is recommended to help reduce swelling and bleeding. E: Educate Education plays a huge part in any injury management. Your physiotherapist will provide education specific to your injury and situation to help you understand your recovery times and what you need to do to get better fast. After the first few days have passed, injuries need ‘LOVE’ L: Load Try to resume normal activities if your pain and symptoms allow; this will promote repair, remodelling and improve tissue tolerance. Your body will tell you when it is okay to increase the load, or if it is not ready. O: Optimism Be optimistic about your recovery! People who are optimistic have better outcomes as the brain plays an important role. Fear and avoidance surrounding your injury can be barriers to recovery. Working with your physiotherapist can help to improve your confidence with getting moving again after your injury. V: Vascularisation Starting some cardiovascular exercise, such as a walking, swimming or a stationary bike will help to increase blood flow to the injured area. This, combined with rehabilitation exercises can help with pain relief and getting your back to your usual activities faster. E: Exercise Your physiotherapist will give you the specific exercises required to rehabilitate your injury and restore factors like mobility, strength and proprioception, as well as helping you to prevent the same injury from occurring again! To find out the best way to manage your injury, book in for an appointment where you will get your own comprehensive and individualised rehabilitation plan.

Heat or Ice – Which is best for my injury?

By Clare Lawson • October 30, 2024
One of the most common questions I get asked is should I use heat or ice for my injury? There’s no correct answer, it ultimately depends on the type of your injury and which stage of the healing process it is at. When should I ice an injury? Ice has traditionally been used straight after an acute injury or surgery. For up to 72 hours after an injury, there is an inflammatory response occurring in the body. Signs of inflammation include localised skin redness, swelling, and heat, as well as pain. Cold therapy helps to reduce the blood flow to the area, thus helping to reduce the inflammation as well as giving pain relief. However, new research is showing that ice has little effect on skin temperature and reducing swelling. While it may numb the area and provide temporary pain relief, it’s ability to accelerate healing beyond the initial stage of an injury appears to be not as effective as we thought it was.  What about ice baths? – see our other blog on them here

What is an APA Sports Physiotherapist?

By Clare Lawson • October 30, 2024
What is a Sports Physiotherapist? They are a highly qualified physiotherapist with expert knowledge and skills in the prevention, diagnosis and treatment of sports injuries. The Title awarded by the Australian Physiotherapy Association, serves as a professional mark of distinction in the field of Sports Physiotherapy, which not all physiotherapists have.  They have undergone intensive training and a rigorous selection process by demonstrating expertise and achieving an outstanding level of contribution to the field of sports physiotherapy. Clare completed this process, obtaining her titling as a Sports Physiotherapist in 2018, after completing a Masters of Sports Physiotherapy degree. Clare has also earnt membership into the Australian College of Physiotherapists; a distinguished group of leaders in physiotherapy clinical practice. Sports Physiotherapists are skilled in fixing all sports injuries and work with people across the physical activity continuum; those returning to exercise, weekend athletes, fitness fanatics and elite athletes. At Refined, you can be reassured that you are receiving the best care with Clare, as she has demonstrated the highest standard of clinical experience and knowledge to accurately identify, prevent and treat injuries.