Beyond Tape: Inversion Ankle Sprains

What is an Inversion Ankle Sprain?

This is an over-stretching or tearing of the ligaments on the outside of the ankle joint and foot. The ligaments most commonly involved are the anterior talofibular ligament toward the front of the ankle, the calcaneofibular ligament directly to the outside of the ankle, and less commonly the posterior talofibular ligament toward the back of the ankle. Thisis is the most common type of ankle sprain, noted as high as 85% of all ankle sprains, and occurs when the foot rolls to the inside with weight bearing activities. This can occur while hiking on uneven ground especially with a heavy pack or when falling from a boulder problem and landing on the edge of the crash pad. Climbing shoes that are excessively small can also contribute to this injury. There has been an increased risk of ankle sprains with bouldering and sport climbing.

What does it feel like (Symptoms)?

Significant pain and swelling is typically noticed on the outside of the ankle and it may be difficult to walk or bear weight on the ankle.

Prevention

There is a high rate of recurrence after the initial sprain so preventing this injury from occurring is key. There are four key factors involved with preventing this injury:

Range of motion and flexibility:

Assess and address as needed any differences between the left and right ankles for dorsiflexion, plantarflexion, inversion, and eversion range of motion as well as gastrocnemius and soleus flexibility. A lack of dorsiflexion specifically has been shown to increase the risk of spraining the ankle.

Strength:

Assess and address as needed any differences in ankle eversion, inversion, and plantarflexion as well as hip abduction and extensor strength.

Balance and proprioception:

Proprioception is a joint’s ability to tell where it is in relation to the rest of the body. Deficits with proprioception can cause the foot to land in a way that increases the chance of a sprain while walking, hiking, or landing from a boulder. The best exercises to address this issue are performed while standing on one leg. The progression of these exercises from easiest to hardest is to stand on one leg on even ground with the eyes open for 60 seconds. If this is easy, try either closing the eyes or standing on an uneven surface such as a wobble board, Bosu ball or, better yet, a slack line. As this becomes easier, stand on the uneven surface with the eyes closed. Adding a single leg quarter squat to this can make it even more challenging.

Crash pad positioning:

Spotters should always have a sense of where the climber will fall and to place the pad so the climber will fall in the middle of the pad as opposed to on the edge. While in the gym or outside, make sure all the pads are connected and there are no spaces where the climber’s foot could land in between pads.

Treatment

This injury should be medically evaluated to determine the extent of the injury including any fractures or dislocations. The use of crutches and functional support using a brace, wrap, or taping while gradually increasing weight bearing may be required if the pain is causing significant limping. Furthermore, there is a high rate of recurrence after an initial ankle sprain and many people develop chronic ankle instability, so it is important to address any of the key factors that may be limited due to an ankle sprain including:

Range of motion/flexibility:

Assess and address as needed any differences between the left and right ankles for dorsiflexion, plantarflexion, inversion, and eversion range of motion as well as gastrocnemius and soleus flexibility. When these motions have been regained with minimal pain, strengthening can be initiated.

Strength:

Assess and address as needed ankle eversion, inversion, and plantarflexion as well as hip abduction and extension strength. Progress through Boxes 2 and 3 below as pain subsides. After these exercises can be per- formed pain free, squat jumps can be added with progressively increasing the height of the jumps and advancing from two legs to single leg as strength increases. These exercises will help the climber prepare for landing while bouldering.

Balance and proprioception:

See details under the prevention section above

Trigger points:

Check for any trigger points, especially of the peroneal muscles as stated above.

Functional support:

Bracing and taping for stability have both been shown to decrease the risk of recurrence after the initial ankle sprain.

Joint mobility:

Joint mobilizations, including mobilizations with movement, typically performed by a physical therapist, chiropractor, or osteopath, have been shown to be beneficial when range of motion is difficult to regain.

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To learn more about climbing injuries, prevention and treatment, buy the book Beyond Tape: The Guide to Climbing Injury Treatment and Prevention.

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Mike Gable, DPT, received his Masters and Doctorate degrees in physical therapy from Pacific University in Oregon. After bouncing around the country through various travel- ling gigs, he serendipitously landed in Bishop, CA in 2005 while on a three-month assignment. Climbing quickly became a new passion. He opened his private practice, Eastern Sierra Physical Therapy Health and Wellness, in 2010, and enjoys seeing a wide variety of conditions with a primary focus on people with climbing and running injuries as well as chronic pain. 

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