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Ankle Sprains Recovery- P.E.A.C.E, L.O.V.E & Rehab!

  • Writer: Jennie Cox
    Jennie Cox
  • Sep 17
  • 5 min read

Ankle sprains, particularly lateral (outer) ligament sprains are pretty common, attributing to up to 10-40% of sporting injuries, depending on the sport.

After many years of playing netball and sport, I had the joy of my first ankle sprain recently, after going for an extra energetic jump while training over Summer!


According to statistics, in sports such as netball, there is a 40% prevalence of ankle sprains (and that seems to be right with how commonly I see them in matches!).

The bad news is that between 20‑30% of those with acute ankle sprains in the UK still have pain or mobility problems nine months later and up to 40% of patients may develop residual symptoms (such as chronic instability, repeated sprains or pain) after an ankle sprain.

Obviously none of us want that in the long run... we want to get back to our beloved sports or general exercise with confidence to perform at our best!


So here's my take, from a Chiropractor's perspective, on the best treatment and rehab advice for ankle sprains (and based on the latest research thoughts, it doesn't include the commonly used RICE!).



A bit on the Anatomy...

For the lateral (outer) ankle ligament complex, which is sprained in 75% of cases, the most frequently damaged ligament is the Anterior Talofibular ligament (ATFL). The mechanism of sprain injury of the ATFL and Calcaneofibular Ligament (CFL) is when a plantarflexed foot is forcefully inverted (pointed down and turned in under load).



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Key risk factors for ankle sprains include: 

  • History of previous lateral ankle sprain.

  • High BMI.

  • Weakness of hip muscles, especially hip extensor strength.

  • Weakness of ankle muscles.

  • Impaired balance.

  • Slow eccentric ankle inversion strength. Fast concentric plantar flexion strength.

  • Passive inversion joint position sense.

  • Reaction time of the peroneus brevis (outer lower leg muscles).



So, looking at proprioception (our ability to sense exact position of our foot e.g. when balancing), and ensuring optimal strength in both fast powerful movements and slow, controlled movements of both the ankle and up the chain at the hip and pelvis is key to eliminate these risks of re-injury!



Ankle sprains can be graded based on the severity of the injury:

  • Grade I- Mild impairment: Minimal swelling and tenderness with little impact on function.

  • Grade II- Moderate impairment: Moderate swelling, pain, and tenderness with decreased range of motion and ankle instability.

  • Grade III- Severe impairment: Significant swelling, tenderness, loss of function, and marked instability.




How to treat ankle sprains with:

P.E.A.C.E & L.O.V.E...


Whereas R.I.C.E (Rest, Ice, Compression, Elevation) was always the accepted protocol, we then went to P.R.I.C.E (Protect, Rest, Ice, Compression, Elevation), P.O.L.I.C.E (Protect, Optimal Loading, Ice, Compression, Elevation)... and now some new thoughts!

P.E.A.C.E & L.O.V.E has now been adopted by many therapists, with a view that the body needs to be allowed to go through the process of acute inflammation to optimise healing, rather than limiting it with Anti-Inflammatory Medications and too much Ice.


So, what does this hippy sounding acronym actually stand for?


P - Protect. Minimise too much movement in the first 1-3 days, let pain be your guide but don't feel you completely have to offload it and brace it if you aren't too swollen or in too much pain.

E - Elevate. If swelling is present. This ideally needs to be above the heart to have an effect.

A - Avoid Anti-Inflammatories. This includes both Anti-Inflammatory Medication such as Ibuprofen (NSAID medication) and Ice! There is a lack of high quality evidence for the use of ice in acute injury recovery, except for analgesic effects. Using anti-inflammatories could delay tissue regeneration and collagen synthesis- and therefore optimal long term healing.

C - Compress. Again if swelling is present. Be sure to ensure good range of motion is still accessible though.

E - Education. Build confidence with education on what is going on in your body and the recovery process.



And after the first few days...


L- Loading. Gradually up the weight bearing to your pain tolerance.

O - Optimism. Be aware of trying to recognise and avoid negative thought spirals, fear and catastrophizing about your injury.

V - Vascularization. Increase blood flow to the area. Even with general cardio like cycling if you can't fully weight bear.

E - Exercise. Working on strength and mobility to restore function. Have a look at my top exercises below!



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How to assess if you're ready to return to sport?


A few simple ways I have used to determine if I'm ready to get back to netball are...


1) The Star Excursion Balance Test- the goal of the SEBT is to maintain single leg stance on one leg while reaching as far as possible with the other leg in all eight sides of a star.

The anterior ('E' below) posteromedial ('B' below, based on the left ankle being grounded/tested) and posterolateral ('H' below) directions appear to be important to identify individuals with chronic ankle instability and athletes at greater risk of lower extremity injury.


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  • Calf Raises- can you get to 30+ single leg calf raises on your effected side? Does it match your unaffected leg?


  • Knee to Wall test- ideally within 2cm of your unaffected leg. (https://www.physio-pedia.com/Knee_to_Wall_Test)


  • Hopping and jumping- can you hop onto and off steps in various directions without pain and imbalance side to side?




Rehab Exercises:

As mentioned earlier, optimal function of the surrounding ankle, hip and core musculature is all important to prevent recurrence. Some of our recommended exercises include:


  • Calf raises- Single leg, 15-20x, 3 sets. Try turning the foot in/out at the top of these to build tolerance to different loads for return to sport.

  • Theraband seated inversion and eversions- slow and controlled, may be useful to start.

  • Single leg squats and courtsey squats, hovering your unaffected foot- using the Star Balance angles! Try with your eyes closed for extra proprioception training!

  • Plyometrics- jumping and hopping in different directions, on and off steps, getting those more sports specific actions and changes of direction in!




What could our Maidstone Clinic Chiropractors, Osteopaths and Massage Therapists do to aid your recovery?

At our Maidstone Clinics, our team can help you in your recovery with:





In Conclusion...

Ankle sprains are very common and unfortunately can cause longer term pain and instability if not treated appropriately. Up to 70% of ankle osteoarthritis cases may be associated with previous ankle injury, so let's get those ligaments some PEACE and LOVE!

Working out the route cause, ensuring proper rehab and restoring full function up the whole kinetic chain is key!



Have a look at our Social Media video to learn more about what I've done to try and ensure full recovery and get myself fighting fit for this Netball Winter Season! ...




Jennie (Chiropractor)





References & Resources:




 
 
 

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