“It’s been 7 years….. why does my sprained ankle still not feel right?”

A quick look at our stats for the past few months revealed that we’ve seen an average of 6 new ankle sprains per week here at STC, so there’s a good chance that you know a Canberran currently nursing a sore and swollen (c)ankle.

Lateral ankle sprains have historically been one of the most common sporting injuries worldwide, and are by far the most common ligament injury. This is partly because they have an extremely high rate of recurring – meaning that once you’ve sprained your ankle, it’s more than likely that you’ll injure it again at some point in the future (most studies rate your probability of a second injury at about 70%).

So why, unlike other injuries, do people continue to repeatedly sprain their ankle long after the original injury has healed? Part of it may be because we tend to view a sprain as a trivial injury, which after a few weeks seems to resolve on its own. Unfortunately, this can hide lingering issues that remain beneath the surface, which can increase our chances of a repeat injury.

When we sprain our ankle, the ligaments that connect the bones of the foot and ankle together are torn apart. As this happens, the tiny rope-like cells inside are damaged, meaning they can no longer send messages to our brain to let it know what’s happening around the ankle (in particular, the messages about where our ankle is positioned in space). While our bodies are fantastic at repairing ligaments with scar tissue, the scar tissue can’t send messages to the brain very well. As a result, the messages being sent between the ankle and your brain are bit slower, so that next time your ankle gets caught in a funny position the brain’s response comes too late to avoid rolling over and spraining the ankle again.

Another reason that these sprains tend to recur is that the ankle muscles get weaker and lazier after your first sprain. The pain caused by a sprained ankle is a powerful signal to the brain, telling it to protect our ankle. As part of this protective response, the brain “shuts down” muscles around the ankle to avoid using it too much until it has healed. Unfortunately, without being stimulated to switch things back on, this can persist well past the first few weeks after your sprain (some studies show evidence of this shut-down in the ankle several years post-injury!), meaning that even though the swelling and pain has gone, your ankle is far weaker and prone to injury than it was before.

On the surface, as your pain and swelling go down it’s easy to assume that your ankle is back to normal. As it starts to feel less stiff and sore, most of us begin to get back into our normal sports and exercise and generally the ankle will actually cope quite well to begin with. 

Underneath the surface however, the muscles that control our ankle are weaker and our ankle is slower to respond when it is put into a dangerous position. So although the ankle may seem like it is good to go, our chances of spraining the ankle a second time are actually at an all-time high. So the next time we land awkwardly, or take a slight mis-step, we can’t react quickly enough and so roll the ankle again. Generally, these repeat injuries tend to result in more damage to the ankle, in some cases leading to fractures requiring surgery.

Many of our repeat offenders, blame their chronic ankle sprains for “never healing properly” or “scar tissue” getting in the way, which goes against the overwhelming scientific evidence that our ligaments are incredibly reliable little healers. Most tears, including full ruptures, can regenerate and form new scar tissue that is just as mechanically stable as the original ligament. Your body will generate this scar tissue for itself without you needing to do a thing. But it won’t necessarily re-learn how to send messages between the ankle and your brain, nor will it strengthen the muscles that help to control your ankle when you land.

A good physio can help to re-train your ankle to send and receive messages from the brain, as well as working out what strategies will help to manage pain, to help reduce your risk of re-injury and get you get back to your normal routine as safely as possible. Get in touch with STC to organise a time to assess your acute ankle injury, or to sit down and talk with an expert to work out why your ankle still isn’t quite right, even after several years.