What is an inversion sprain of the ankle?
The most common mechanism for spraining your ankle is to “roll over” on it. This causes the foot to “invert” with the sole turning in and under the shin, spraining the ligaments on the outside of the ankle. These are graded from 1-3.
Grade 1: The tearing of the ligament is minimal, sort of like if I grabbed your T-Shirt and yanked it. You’ll hear some fibers parting but there won’t be an obvious defect you can see. These take 10-14 days to settle and have no major lasting impart……other than slightly weakening the support structures and increasing the risk of another “inversion event”.
Grade 2: These are a different matter. You will likely get bruising because the degree of tearing is much greater, thus more bleeding occurs. In the T-Shirt example, the damage is a visible hole in the fabric. These are always painful and often cause a major change in gait (the way you walk). The healing time is much longer, on the order of 3-6 months, and even then the ligaments aren’t as strong as they once were. You don’t heal the injury with a new ligament, it is a fibrous repair that is not nearly as good at bearing load. Sort of like repairing the tear in your black Led Zeppelin T-Shirt with white thread. It isn’t woven material, it doesn’t look the same and if you pull on it, it will tear again easily. The other problem with Grade 2 and 3 sprains is that you’ve caused damage to the muscle and tendons up the outside of the shin (the peroneus or fibularis muscle group). Often these go unnoticed because of the pain at the ankle, but loss of muscle strength in these will substantially increase the risk of a repeat event. So even when the ankle is feeling better, you need to be improving balance and strength to reduce the risk of repeats. A large part of the rehabilitation is not only ankle range of motion but stability and strength of the supporting muscles and tendons.
Grade 3: Messy!! But there is very little pain involved… this is a complete tear of the ligament that holds your shin to your ankle. Your Chiropractor can move the ankle a long way into inversion , practically showing the patient the bottom of their own foot, with little pain. In these cases a medical opinion is critical. Sometimes the ankle is just immobilized to allow the two parts of the ligament to reunite, and sometimes they need to be surgically repaired. But in all cases of Grade 3 sprains, we make a referral for a medical opinion as this is out of our field of expertise. Once the opinion has been given we are happy to help with the rehab process using graduated exercise protocols. First gentle stretching and mobilizations, then starting with unweighted strengthening, progressing to weight bearing exercise, balance and proprioceptive tasks to help restore as much function as possible to the foot/ankle, leg and body.
Dr. Eric Jackson