A high ankle sprain occurs when the ligaments above and around the ankle (see image below) get damaged or over-stretched. High ankle sprains are more serious than other ankle sprains because these specific ligaments hold the two lower bones of the shin together.
These ligaments also provide stability and absorb large amounts of force during dynamic activities such as walking, running, jumping and cutting, or pretty much any other move athletes make during sport.
Ankle sprains are a common occurrence among athletes in all sports, but most of those ankle injuries are what’s called an in inversion ankle sprain, which can take about two days to 2 weeks to heal depending on severity. Unfortunately, the high ankle sprain is a more serious ankle issue, with a longer healing time.
What Causes High Ankle Sprains?
The high ankle ligament that is most commonly injured is the interosseous ligament, which spreads like a web between the two bones of the shin that run from the top of the ankle to the bottom of the knee. The more typical inversion ankle sprains do not usually involve the interosseous ligament.
This ligament is typically injured when a large compression force impacts the ankle, such as jamming the ankle into the ground when landing. Combine this with rotational stress, in which the foot is turned outside in respect to the leg, and you have a recipe for a high ankle sprain.
For example, in basketball high ankle sprains typically occur when two players contesting for a rebound and collide with one another, and one strikes the other’s knee while landing. The actual mechanism of injury occurs when the two shin bones are pushed apart, causing an overstretch or tear of the interosseous ligament if enough force is applied.
What are the Symptoms of a High Ankle Sprain?
Although high ankle sprains are less common than inversion sprains, they are easy to diagnose. A trademark sign is the swelling and bruising on the inside, outside and higher portion of the ankle that typically occurs within 24 hours of the injury.
A common bruising pattern for high ankle sprains
When any ankle sprain occurs, it’s important to ice immediately, rest, elevate and compress. During this time, it will be difficult to walk due to pain throughout the ankle.
Once the inflammation has subsided, there are a few special tests that indicate a high ankle sprain and rule out any fractures. These tests, like the “squeeze test,” are usually performed by a team doctor, physical therapist or athletic trainer to determine whether an X-ray is needed.
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High Ankle Sprain Recovery Timeline
Ligaments have a much longer recovery time, anywhere from 4 to 8 weeks. The actual recovery time depends on the grade of the ligament sprain: grade 1 is a micro tear; grade 2 is more than 50 percent torn; and grade 3 is a complete tear.
Other factors that affect recovery include progressing the amount of weight-bearing too quickly, adhering to a strengthening program, and healing genetics. Fortunately, a grade 1 or grade 2 sprain often does not require surgical intervention, and responds well to treatment provided by physical therapy.
RELATED: How to Prevent High Ankle Sprains
High Ankle Sprain Treatment
Within the first 24 to 48 hours RICE (rest, ice, compression, elevation) is crucial to the recovery process. As swelling subsides, a slow progression of pain-free passive and active range of motion of the ankle can occur with light Theraband resistance.
When transitioning back to normal activity, the athlete may need to wear a boot in order to stabilize the ankle and limit the amount of weight the joint absorbs.
Throughout the rehabilitation process, the physical therapist will progressively increase the amount of load the ankle can handle until the athlete is back to full weight-bearing.
The first goal is returning the ankle to its previous range of motion in all directions. In my experience as a ProSport / STACK physical therapist, pain is the largest limitation in an athlete’s recovery. I have found that the ZAMST A2-DX brace helps support the interosseous ligament, reducing pain significantly without completely limiting range of motion.
Once basic strength is achieved and weight-bearing is pain-free, dynamic strength control and single leg balance exercises can be incorporated into an athlete’s exercise program. In the final stages of rehabilitation, a progression through agility and plyometrics should be tested and built before returning to sport.
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High Ankle Sprain Taping Technique
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High Ankle Sprain Prevention
Of course, the best rehabilitation for any injury is prevention. Although it is impossible to eliminate random occurrences of every injury, athletes can take some steps to reduce the chances:
Dynamic single-leg balance. Perform various activities while standing on one leg. The simplest exercise is just standing on one leg. Progress by changing the surface the athlete stands on to something less stable such as an Airex pad. Once the athlete demonstrates proper stability, add distracting elements such as throwing a basketball or upper-body rotations.
Proprioceptive awareness. Move the foot in specific directions with eyes open and progress to eyes closed. For example, spell out the alphabet with the foot. Eventually progress to single-leg balance with eyes closed.
Lower extremity strength training. Traditional exercises that progress from theraband resistance to weighted Squats, Lunges, Calf Raises, etc.
A well planned off-season performance program is a great way to maximize movement mechanics while minimizing the risk of injury and improving the longevity of an athlete’s career.