lateral ankle sprains in sport - should we be doing more to prevent and manage them?

How common are lateral ankle sprains? 

A lateral ankle sprain (rolled ankle) occurs when there is rapid inversion (foot turns inwards) of the ankle with associated internal rotation, with or without the presence of plantarflexion (toes pointed) causing damage to the lateral (outside) ligaments of the ankle(5). Lateral ankle sprains are very common in court sports, such as netball and basketball, as well as in field sports such as rugby and soccer. In the USA, it is thought that lateral ankle sprains cost in excess of $2 billion per year(4). And this is not an issue that is getting any better. A 2020 NZ study found that injury rates in netball, for example, have increased in the last 10 years, with ankle injuries in particular rising by 84%(1). 

Not just a "few weeks rest" and then you're good to go….

Often, ankle sprains are managed by a period of a few weeks' rest before returning to sport, with little focus on graduated rehabilitation to restore strength, balance, and landing control. 

An acute ankle sprain can lead to chronic ankle instability. As many as 64% of all athletes who have had a prior ankle sprain report at least a moderate amount of ongoing instability(2), and up to 70%(11) are likely to sprain their ankle again in their lifetime.  Ongoing pain and instability as a result of an ankle sprain can cause people to drop out of sport, leading to further negative health outcomes associated with inactivity. Ongoing instability can also lead to the development of osteoarthritis.
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Prevention is the best strategy to minimise the issues associated with ankle sprains, considering the negative consequences that can come about from a single episode.

Risk factors leading to ankle sprains:

• Previous ankle sprain (2)
• Reduced hip muscle strength (2)
• Reduced balance and proprioception (2)
• Direct contact with opposition
• Foot landing in a more inverted position (2,5)

Recommended injury risk reduction strategies

• Consider ankle bracing or taping during sport. This has the potential to reduce ankle sprains by up to 64%(9).
• Anyone who plays sport should participate in an injury prevention program on an ongoing basis (at least twice per week for minium 30 minutes). There is evidence to suggest that a strength and balance program can reduce ankle sprains by up to 46%(10).
• There is no set duration for which this may be beneficial; however it is likely the the effects are cumulative, and the effects are likely to reduce with cessation of the program(8). 
• This program should include strengthening of the entire lower limb, including core and hip strength; balance and proprioception training; and landing control exercises (8). 

resources for exercise programs to reduce risk 

Netball knee 
​Though this is specifically for knees, it has a program that is helpful to reduce injuries across the whole lower limb. 
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​FIFA 11 
The FIFA 11 program has been shown to reduce soccer injuries by up to 50% in studies of over 4000 kids.

Exercises you can try: 

If you have had an ankle sprain before, or are interested in reducing your risk in getting one, aside from having a look at the resources above there are a few exercises you could do to strengthen up around the foot and ankle.

NOTE this post is NOT intended as medical advice; exercises are completed at your own risk!

For a more targeted approach to reducing your injury risk during sport; to book an injury risk assessment screen; to enquire about injury prevention classes; or to find out how to get back to sport safely if you have recently hurt your ankle, please get in contact ! Online as well as in person consults available in Clayfield, Brisbane, Australia. 

REFERENCES
​1.Belcher, S., Whatman, C., Brughelli, M., & Borotkanics, R. (2020). Ten-year nationwide review of netball ankle and knee injuries in New Zealand. Journal of Science and Medicine in Sport. doi:https://doi.org/10.1016/j.jsams.2020.04.004
2.Delahunt, E., & Remus, A. (2019). Risk Factors for Lateral Ankle Sprains and Chronic Ankle Instability. Journal of athletic training, 54(6), 611-616. doi:10.4085/1062-6050-44-18
3.De Ridder, R., Witvrouw, E., Dolphens, M., Roosen, P., & Van Ginckel, A. (2017). Hip Strength as an Intrinsic Risk Factor for Lateral Ankle Sprains in Youth Soccer Players: A 3-Season Prospective Study. The American journal of sports medicine, 45(2), 410-416. doi:10.1177/0363546516672650
4.Finch, C. F., Kemp, J. L., & Clapperton, A. J. (2015). The incidence and burden of hospital-treated sports-related injury in people aged 15+ years in Victoria, Australia, 2004-2010: a future epidemic of osteoarthritis? Osteoarthritis and Cartilage, 23(7), 1138-1143. doi:10.1016/j.joca.2015.02.165
5.Fong, D. T., Ha, S. C.,  Kam-Ming, M., Mok, K., Chan, C. W., & Chan, K. (2012). Kinematics Analysis of Ankle Inversion Ligamentous Sprain Injuries in Sports: Five Cases From Televised Tennis Competitions. American Journal of Sports Medicine, 40(11), 2627-2632. doi:10.1177/0363546512458259
6.Kaminski, T. W., Needle, A. R., & Delahunt, E. (2019). Prevention of Lateral Ankle Sprains. Journal of athletic training, 54(6), 650-661. doi:10.4085/1062-6050-487-17
7.Ko, J., Rosen, A. B., & Brown, C. N. (2018). Functional performance tests identify lateral ankle sprain risk: A prospective pilot study in adolescent soccer players. Scand J Med Sci Sports, 28(12), 2611-2616. doi:10.1111/sms.13279
8.Schiftan, G. S., Ross, L. A., & Hahne, A. J. (2015). The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport, 18(3), 238-244. doi:10.1016/j.jsams.2014.04.005
9.Verhagen, E. A. L. M., & Bay, K. (2010). Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. British Journal of Sports Medicine, 44(15), 1082-1088. doi:10.1136/bjsm.2010.076406
10. Bellows, R., & Wong, C. K. (2018). THE EFFECT OF BRACING AND BALANCE TRAINING ON ANKLE SPRAIN INCIDENCE AMONG ATHLETES: A SYSTEMATIC REVIEW WITH META-ANALYSIS. International journal of sports physical therapy, 13(3), 379-388
11.Delahunt, E., Bleakley, C., Bossard, D., Caulfield, B., Docherty, C., Doherty, C., . Gribble, P. (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, bjsports-2017. doi:10.1136/bjsports-2017-098885