Simple ankle sprain not always so simple

Jul27th 2018

For anyone who has ever laced up a pair of cleats, running shoes, or as my boys like to tease me, “sneakers”, then almost all of you have probably suffered an ankle sprain at some time in your life. The most common variety: Inversion ankle sprain, which is more casually referred to as “rolling your ankle” (where the foot turns in while all the weight goes to the outside of the lower leg). Other ankle injuries can occur, but let’s stick to the more common type.

First priority: determine if it is simply a low grade type of ankle sprain, and not something more serious. One of the classic signs of a serious injury is the inability, or refusal, of the individual to bear any weight immediately after the injury. This may indicate the need for more formal diagnostic imaging and medical care.

Second priority: control the swelling. This is most likely caused by small vessel damage and subsequent bleeding. This is the best time for ice, compression, and elevation to be used. Once 2-3 days have passed, and more serious conditions are eliminated, switching to heat and gentle movement is probably best. But the swelling and soreness from the initial vascular injury are not the only causes of ankle pain.

Third priority: assess for joint dysfunctions and nerve irritability. Some ankle pain may linger for a time after the initial bruising and swelling have cleared. Causes could be the joint is stuck out of position, or shifted. In fact, a one-degree deviation from the normal resting position of the ankle increases the forces in the ankle by 42% when your full weight is on it (ACSM, 2017). Manipulation to restore proper alignment and mobility may be needed.

In base level orthopedic physical therapy, nerve pain is often overlooked when treating the ankle. The Intermediate Dorsal Cutaneous Nerve, a branch of the Superficial Fibular (peroneal) Nerve, travels directly over the front of the talofibular ligament, and may also be what is tender when pressed (see bottom left portion of image). Austin Manual Therapy Fellowship-trained Manual Physical Therapists are specifically trained to examine and evaluate every potential source of pain for a “simple” ankle sprain, including nerve pain.

At Austin Manual Therapy, we provide a uniquely thorough and holistic evaluation for every patient, every time (no two ankle injuries are the same). We have the highest expertise, the most advanced specialized training in Orthopedic Physical Therapy comprehensive examination and diagnosis to get to the root of the problem, the “cause of the cause”, if you will. Whether you wear sneakers or not, our treatments will address your immediate needs, and add preventative measures to help reduce likelihood of a recurrence.

Ask yourself the next time it happens, if your “simple” ankle sprain is just that; simple. Come see us at Austin Manual Therapy and we’ll help you figure out what the problem is, correct it, and help you protect the ankle in the future. You can reach us at (512) 832-9411, or

James Harris, PT, DPT, OCS, FAAOMPT