Lateral Ligament Sprains: A Common and Risky Injury in Sports
/Lateral ligament injuries to the ankle are far more common than many people realise, accounting for 85% of all ankle injuries. In fact, studies show that up to 40% of all sporting injuries are related to lateral ligament sprains, making them one of the most frequent and disruptive injuries in sports, especially in high-contact or indoor sports like basketball.
Lateral ligament sprains are also the leading cause of time lost from sports—meaning athletes can miss significant amounts of time while recovering. What’s particularly concerning is that previous injuries are the biggest risk factor for future ankle sprains. Research has shown that after an initial ankle sprain, the body's ability to absorb energy during landing is reduced by 60%, making the ankle more susceptible to reinjury.
This highlights an important issue: rehabilitation. The effectiveness of rehab after an ankle sprain is critical, and unfortunately, it seems that many people don’t fully recover. In fact, many athletes or individuals may not undergo proper rehabilitation, leading to increased vulnerability to future sprains. This makes it incredibly important to not only assess whether someone has had a previous ankle sprain but also to understand the nature and quality of the rehab they underwent.
Mechanism of Injury and Severity of Lateral Ligament Sprains
The most common mechanism of injury (MOI) for lateral ligament sprains occurs when an individual lands on the outer border of the foot, often in combination with forced plantar flexion (pointing the foot down) and inversion (turning the foot inward). This motion stretches or tears the ligaments on the outside of the ankle, resulting in a sprain.
Interestingly, the severity of the sprain doesn’t always correlate with the number of ligaments involved. Whether it's a sprain to just one ligament or multiple ligaments, the grade of the injury is the biggest prognostic factor for recovery. In other words, the grading system (Grade 1, 2, or 3) plays a more significant role in determining recovery time than the number of ligaments affected.
Grade 1 and 2 sprains usually take between 5-14 days for recovery, depending on the severity.
Grade 3 sprains or chronic sprains may require anywhere from 3 to 12 weeks to heal fully
Please note: recovery time varies based on the individual and the demands of the sport they are returning to.
Clinical Assessment of Ankle Ligament Sprains: Challenges and Best Practices
When it comes to diagnosing lateral ligament sprains, clinical assessment plays a crucial role. However, there’s an important caveat: clinical testing for ligament damage is often unreliable within the first 3-5 days after the injury. This is due to the swelling and inflammation that typically occur in the initial stages of an ankle sprain, which can mask the true extent of ligament damage.
For this reason, it’s recommended to re-test the injury around Day 5 post-injury, and continue to reassess throughout the following days as swelling decreases and the injury stabilises. By waiting a few days, clinicians can get a clearer sense of the true nature of the injury and its severity.
Cluster Testing: A Reliable Approach for Diagnosing Mechanical Instability
One of the most effective methods for assessing true instability in the ankle is cluster testing—a combination of tests that, when all return positive, strongly suggest true ligament instability. The three key tests in this cluster include:
Pain on palpation of the lateral ligaments: This test checks for tenderness and swelling along the outer (lateral) ligaments of the ankle, specifically the ATFL (anterior talofibular ligament) and CFL (calcaneofibular ligament).
Haematoma over the lateral area: Bruising and swelling over the lateral side of the ankle is a common sign of ligament injury, signalling trauma to the tissue.
Positive Anterior Drawer Test: This test assesses the integrity of the ATFL by gently pulling the foot forward while the ankle is in a neutral position. A positive sign indicates that the ligament may have been stretched or torn, leading to instability.
If all three tests come back positive, it is generally considered a strong indication of true mechanical instability, meaning that the ligament or ligaments are significantly compromised, and the ankle may not be stable during movement or weight-bearing.
Rehabilitation for Lateral Ligament Injuries: What You Need to Know
The rehabilitation process for lateral ligament injuries plays a key role in recovery, and it starts immediately after the injury occurs. The first 72 hours are crucial for managing pain, swelling, and the initial healing process. During this time, the recommended approach is known as “PEACE & LOVE”, which stands for:
PEACE: Protect, Elevate, Avoid, Compress, Educate
LOVE: Load, Optimism, Vascularization, Exercise
This method emphasises protecting the injury in the acute phase, while gradually starting to load the joint as recovery progresses.
The First 72 Hours: Managing Pain and Swelling
Compression: For the first 24 hours, applying compression helps reduce swelling and provides support to the injured area.
NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and swelling, but it’s best to wait at least 72 hours before starting them. This delay allows for natural healing and reduces the risk of interfering with tissue repair.
To Immobilise or Not to Immobilise?
One of the big questions in rehabilitation is whether to immobilise the ankle during the early stages of recovery, particularly if there is no rupture. The general recommendation is to avoid complete immobilisation, as it can slow down the recovery process. Immobilising the ankle for too long can result in stiffness, reduced range of motion, and proprioception—the body’s ability to sense movement and position.
Instead, taping is often preferred in the early stages. This method provides the necessary support and comfort while still allowing for mobility. This also helps prevent further injury and can facilitate the regaining of ankle function more quickly, especially when it comes to weight-bearing and movement.
Ruptures: A Different Approach
In cases where the ligament has ruptured, immobilisation is often required for a period of 4-6 weeks, typically in the form of a brace. However, even with a rupture, the goal is still to optimally load the ankle as soon as possible. This helps stimulate healing and maintain strength in surrounding muscles.
Weight-Bearing and Rehab
It’s important to begin weight-bearing as soon as tolerated. The key factor here is pain and swelling—as long as these are manageable, weight-bearing activities should start early. Typically, rehab can begin around 3 days post-injury, but it’s essential to proceed cautiously, adjusting based on how the ankle is responding.
At this stage in your recovery, we highly recommended you seek an assessment from your physiotherapist. Here at BIM we can help evaluate your injury and provide individualised treatment that focuses on key areas like regaining range of motion, strength, and proprioception. Treatment plans will be tailored to your specific goals, whether that’s returning to daily activities or getting back to sport. Early and effective rehabilitation can make a significant difference in preventing future injury and ensuring a full recovery.
Jess Rose