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Understanding Ankle Sprains

Ankle Sprains, The Athlete's Parent

Ankle sprains are one of the most common injuries in musculoskeletal and sports medicine. Typically an ankle sprain involves an injury that leads to a tearing of the lateral ligaments, which run horizontally across the ankle and are more prone to tearing than other stronger and broader ankle ligament groups like the deltoid.


Complications usually include injuries to the tibial fibular ligament, located above the top of the ankle and connecting the tibia and fibula, the two main leg bones below the knee. Known as a high sprain, this injury complicates the return to play and makes the road to recovery a lot more difficult. Other common complications include injury to the peroneal tendon, which runs from the ankle down the outside of the foot, or associated avulsion fractions that occur when a piece of bone tears away from the main bone.


In the course of treating an ankle sprain, several steps are necessary. The first is protection, which can include bracing, taping, crutches, walking boots or even a cast. Secondly and simultaneous with the first step, is an attempt to reduce pain and swelling, an essential part of treatment. This can be accomplished with icing, medications, compression, elevation and other treatments like electrical stimulation and ultrasounds, which are commonly used in a physical therapy setting. The third and most important step includes rehabilitating the ankle injury. Rehabilitation includes addressing range of motion, stretching and flexibility, and strengthening. For optimal results, rehab should be started as soon as safely possible.

Return to Activity

Finally, the last step in treatment is progression toward usual sport activity. This includes a functional progression program, which helps athletes progress from general activities such as walking, jogging, running or sprinting into more specific sport activities such as dribbling a soccer ball or moving laterally to dig out a volleyball. It’s important to remember that every injury progresses differently and depends largely on the individual. Mild and short-term injuries may progress rapidly, while more significant injuries, like grade III sprains with a high sprain component or other complications, may progress more gradually.

Ultimately, an office test can help guide physicians, trainers, and other medical personnel when dealing with an athlete’s ankle sprain. This five-step test, which should be performed under close supervision of a sports professional, may include:

  1. Walk steps across the office and back

  2. Tiptoe three steps and back

  3. Hop on both feet six times

  4. Hopping on the injured foot six times

  5. Balance on the injured foot for 10 seconds

When athletes are ready to perform this simple clinical test, they are generally at least 75 to 80 percent improved and may be ready to return to sport activity with appropriate protection of taping or bracing. At the beginning, athletes will find they may experience some muscle soreness and/or tightness or ache in the ankle. These are all a normal part of returning from an ankle sprain. In most cases, athletes will improve shortly after a workout and with an ice treatment of about 10 to 15 minutes. Athletes who have an unstable “giving way” feel, significant swelling in the ankles or sharp pain that lasts longer than a half-hour after working out should be re-evaluated by their trainer, physician or other medical professional.

Read More Articles by Dr. Smurawa regarding youth athletes:

Soccer Injury Prevention and Treatment

Hydration Guidelines for Youth Athletes

Surviving Two-A-Day or Prolonged Practices

Troy M. Smurawa, M.D., Director of Pediatric Sports Medicine, Children’s Health Andrews Institute for Orthopaedics & Sports Medicine

Troy Smurawa, M.D.

Board-certified in both pediatrics and sports medicine, Dr. Troy Smurawa is the director of pediatric sports medicine at the Children’s Health Andrews Institute for Orthopaedics & Sports Medicine in Plano, Texas. Dr. Smurawa earned his medical degree from The University of Texas Health Science Center and did his residency in pediatrics at the University of Wisconsin. He completed a sports medicine fellowship at Children’s Hospital Medical Center in Akron, Ohio.

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