Ankle sprains are one of the most common musculoskeletal injuries, affecting people of all ages and activity levels. Understanding the different types of ankle sprains, the strength deficiencies contributing to their occurrence, and effective rehabilitation and prevention techniques is crucial for optimizing recovery and reducing the risk of future injuries. In this post we want to provide an overview of ankle sprains, delve into potential strength deficiencies contributing to their occurrence, discuss the beginning steps of rehabbing a sprain using the Peace and Love practice, and offer exercises to prevent ankle sprains. That being said, it is of course best if you come in to see us so one of our specialists can help get you started on the right path to stronger ankles.

What is an ankle sprain? Ankle sprains occur when the ligaments connecting the bones of the ankle joint are stretched or torn due to excessive or unnatural forces. They are classified into three types based on the severity of the injury: Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe). Grade 1 sprains involve minimal tearing of ligament fibers, Grade 2 involve partial tearing, and Grade 3 result in complete ligament rupture.

Several strength deficiencies can increase the likelihood of ankle sprains. These deficiencies include:

• Weak Ankles: Insufficient strength in the muscles surrounding the ankle joint, particularly the peroneal muscles, can lead to decreased stability and an increased risk of sprains.

• Poor Balance and Proprioception: Inadequate proprioception, the body's awareness of its position in space, can affect ankle stability and lead to missteps that may result in sprains.

• Limited Range of Motion (ROM): Reduced ankle joint ROM can place greater stress on the ligaments, making them more susceptible to injury during physical activities.

• Weak Hip and Core Muscles: Weakness in the hip and core muscles can alter lower limb biomechanics, leading to improper foot placement and increased risk of ankle sprains.

Previously, it was taught widely that the best rehab protocol for soft tissue injuries like an ankle sprain was RICE, which stands for Rest, Ice, Compression, and Elevation. According to the British Journal of Sports Medicine, “Although widely known, the previous acronyms focus on acute management, unfortunately ignoring subacute and chronic stages of tissue healing. Our contemporary acronyms encompass the rehabilitation continuum from immediate care (PEACE) to subsequent management (LOVE).” PEACE and LOVE outline the importance of educating patients and addressing psychosocial factors to enhance recovery. 

P for Protect: An injured person should unload or restrict movement for one to three days post-injury. It’s important that this period shouldn’t be too long because too much rest can compromise tissue strength and quality. 

E for Elevate: An injured person should elevate the affected limb so that it’s higher than their heart to allow fluid to flow out of the injured tissues.

A for Avoid anti-inflammatories: The various stages of inflammation are good for promoting healing, the researchers say, so inhibiting inflammation with medications can slow down the healing process, and could negatively affect long-term tissue healing. The research also discourages athletes from using cryotherapy (a.k.a. icing the injury), because there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries.

C for Compress: “External mechanical pressure using taping or bandages helps limit intra-articular edema and tissue hemorrhage,” the researchers say.

E for Educate: The researchers argue that therapists should educate patients on the benefits of an active approach to healing. They note that treatments such as electrotherapy, manual therapy or acupuncture have little effect in the early stages of healing, and may even be counterproductive in the long term. Better education around treatment and load management can also avoid over-treating, reducing the likelihood of unnecessary injections or surgery. (if you’ve been to Peak Performance before, you’ll have heard us talk about Load & Capacity, and this is why we teach about it. Here is an article by our own Dr. Kevin Maggs from the British Journal of Sports Medicine on the topic)

And Love:

L for load: Researchers say mechanical stress should be added early and normal activities should be resumed as soon as symptoms allow. Optimal loading without exacerbating pain promotes repair, remodeling, and builds tissue tolerance and the capacity of tendons, muscles, and ligaments through mechanotransduction (the mechanism by which cells convert mechanical stimuli into cellular responses to a variety of mechanical loads.)

O is for optimism: An optimistic outlook on your injury is associated with better outcomes and prognosis. For example, beliefs and emotions are thought to explain more of the variation in symptoms following an ankle sprain than the degree of pathophysiology.

V for vascularisation: Pain-free aerobic exercise should be started a few days after the injury to improve blood flow to the injured area. It is believed that early mobilization and activity help people reduce their need for pain medication.

E for exercise: Exercises help restore mobility, strength and proprioception to an injured area early after an injury. As long as the exercises prescribed can be carried out without pain, they improve recovery time and can improve long-term outcomes for athletes. After all, exercise is medicine.

It's not uncommon to be told to “walk it off” after an injury. While that is a really blunt and generalized recommendation, it turns out it may have had some merit after all, in that it stimulates blood flow and follows loosely with the above recommendations. Understanding the different types of ankle sprains, identifying potential strength deficiencies, and adopting the Peace and Love practice during rehabilitation can aid in effective recovery and reduce the risk of future ankle injuries. Additionally, incorporating specific exercises to strengthen the ankle and surrounding muscles can play a significant role in preventing ankle sprains and maintaining overall ankle health. Remember, we can help get you on the right track with exercise loading and lifestyle recommendations that are right for you.