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Understanding Ankle Instability

How many of us reading this have suffered an ankle sprain, commonly known as a “rolled ankle?” I know I have.

Are you like many of patients who have suffered multiple ankle sprains/rolls?

Do you feel like your ankle gives way on you?

This is a common occurrence. Multiple studies have shown that there is a high recurrence rate for acute ankle sprains (McKenzie et al, 2019). And about 70% of people note some level of disability secondary to an acute ankle sprain (McKenzie et al.)

Ankle sprains are one of the most common injuries documented among the active population (McKenzie et al, 2019). But what constitutes a sprain? There are various grades of strains: a Grade I strain is a stretching of connective tissue (aka fibers) of the ligament with minimal to no dysfunction noted to the matrix, Grade II is a partial tearing of the ligament which increases laxity in the ankle, Grade III is a complete tear of the ligament, with Grade III being the most severe (Encarnacia, 2015). Each grade tends to correlate to increased dysfunction and prolonged recovery time with multiple different approaches to recovery being cited.

The most prevalent ankle sprain is a lateral ankle sprain which most often involves injury to anterior talofibular ligament (ATF) then the calcaneofibular ligament (CF) (ATF and CF are commonly injured at the same time), less common is damage to the posterior talofibular ligament (Melanson et al, 2023). A medial (i.e. inside portion of ankle) ankle sprain, is far less common than a lateral, which occurs to the inside of the ankle. The inherent stability of the medial ankle is secondary to the deltoid ligament being the strongest of the ankle ligaments. Lateral ankle sprains happen when our foot rolls underneath our leg, whereas a medial ankle sprain has the ankle roll out. These 4 ligaments provide static stability to the ankle, and damage to any one of these structures lends to increased laxity and mobility in the ankle. This increased laxity places the ankle at increased risk for a secondary sprain.

Ankle sprains are painful experiences and cause a multitude of dysfunction, but it is important for healthcare practitioners to rule out fracture. The Ottawa Ankle Rules state that an ankle x-ray is warranted if there is tenderness along the distal portion of the medial or lateral ankle bone (distal 6 cm to be exact) and inability to bear weight follow the injury and unable to walk 4 steps at initial evaluation to rule of fracture of the ankle (Ottawa Ankle Rules).

The treatment for these injuries is multifactorial ranging from manual skills to elevation/compression to exercise and balance training.

If you have suffered an ankle sprain and continue to struggle with instability that limits your lifts, running, ability to compete in your favorite activity, it might be time to address these limitations. Do you still feel unbalanced, suffer from ankle pain, feel like you are in this vicious cycle of workout, injury, recover? Contact us for an individualized assessment and treatment protocol that addresses you as a whole person. We find the pieces to what feels like the illusive puzzle of your pain, and help bring you to the strongest version of yourself. We use a 3-step process to help athletes feel better and move better:

  1. Fixing your pain.

  2. Figuring out the root cause.

  3. Providing you the necessary tools to get back to being active and not dealing with this again.


Encarnacion, T. (2015, November 5). Ankle sprain. UConn Musculoskeletal Institute.

Mackenzie M. Herzog, Zachary Y. Kerr, Stephen W. Marshall, Erik A. Wikstrom; Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train 1 June 2019; 54 (6): 603–610. doi:

Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:

Ottawa ankle rules. Physiopedia. (n.d.).

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