Ankle Sprains

What is an ankle sprain?

The ankle is a complex maze of ligaments which allow for movement in multiple planes of action. Sprains can be stretches of the ligament (type I), a partial tear of the ligament (type II) or complete tear/disruption of the involved ligament(s) (type III).  For type I sprains, symptoms dictate return to play. Type II and III may require more formal rehabilitation or surgical repair, with delays as expected.

Who is at risk for an ankle sprain?

Athletes of all ages and participating in many types of sports can increase the risk of ankle injuries. 85% of all ankle injuries are sprains, and most of these are lateral sprains. Females have slightly more lateral ankle injuries while males tend to experience more medial ankle sprains. The most common ligament sprain is the anterior talofibular ligament.

Risk factors for ankle sprains are increased height or weight, overall increased body mass index, and certain high impact, fast paced sports like basketball, soccer, volleyball, football, cheerleading, rugby, gymnastics and dance.

Here’s an interesting link to a study evaluating ballet dancers and monitoring movement to predict injury patterns:

How can I improve my ankle stability?

Many studies document how ankle strength and posture improve stability and help prevent sprains.

Ankle Muscle Activation

Three ankle muscles important in forward/backward and lateral stability are the peroneus longus, tibialis anterior and soleus. Using stable and unstable surfaces (such as a rocker board) regularly can strengthen these muscles, thereby reducing the risk of severe ligament sprain.

Posture Control

Improved core strength can help improve overall balance and reduce risks of ankle sprains. One study found that female athletes tended to have better balance than males due to their participation in sports requiring upright posture (like dance or gymnastics). In addition, tall stature and muscular build, two characteristics that are more commonly found in men, can negatively affect balance by affecting the center of gravity.

I already have sprained my ankle. How can I prevent another?

Any ankle rehabilitation program works to help prevent recurrent sprains. There are formal programs to help with acute rehabilitation (physical therapy or athletic trainer).  Even phone apps, kinetic video game systems, and feedback devices such as smart watches can help monitor and track exercises. As seen in formal randomized studies comparing various programs, the key to prevention is performing the exercises regularly.


Grass A, et al. Postural stability deficit could predict ankle sprains: a systematic review. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (2018) 26:3140-3155.

Howell D, Hanson E, Sugimoto D, Stracciolini A, Meehan W. Assessment of the postural stability of female and male athletes. Clinical Journal of Sport Medicine (2017) 27:444-449.

Borreani S, et al. Exercise intensity progression for exercises performed on unstable and stable platforms based on ankle muscle activation. Gait & Posture (2014) 39:404-409.

Reijen M, Vriend I, Zuidema V, van Mechelen W, Verhagen E. The “Strengthen your ankle” program to prevent recurrent injuries: A randomized controlled trial aimed at long-term effectiveness. Journal of Science and Medicine in Sport (2017) 20:549-554.

Richardson D. Sports injuries of the Ankle (Chapter 89). Campbell’s Operative Orthopaedics, edition 4.  Elsevier.

By Leigh Anne Costanzo, DO and Alee Vladyka, ATC