1. Introduction / Plain Theory

An ankle sprain is an injury to the ligaments surrounding the ankle joint, most commonly affecting the lateral ligaments (anterior talofibular and calcaneofibular ligaments).
It typically occurs when the foot rolls inward (inversion) during sudden movement, causing ligament overstretch or tearing.

While many sprains heal spontaneously, up to 40% of cases develop into chronic ankle instability (CAI) — characterised by recurrent sprains, weakness, or a persistent sense of “giving way.”

Beyond local ligament damage, ankle sprains can disrupt proprioception, muscle coordination, and joint mechanics throughout the lower limb.
Even mild sprains may alter gait and load distribution long after pain has subsided.

2. Typical Symptoms and Functional Impact

• Pain and swelling around the ankle, often on the outer (lateral) side.

• Bruising and tenderness after injury.

• Difficulty bearing weight or walking normally.

• Recurrent sprains or a sensation of instability (“ankle rolling”).

• Decreased balance and proprioception.

Functional impact:
Ankle sprains can limit walking, sports, and confidence in movement.
Untreated instability can lead to chronic pain, reduced performance, and compensatory issues in the knees, hips, and back.

Red flags:
Severe pain, inability to bear weight, or visible deformity may indicate fracture and should be medically evaluated.

3. Contributing Factors / Underlying Causes

Ankle sprains and instability arise from a combination of traumatic injury and insufficient neuromuscular recovery.
Common contributing factors include:

• Previous ankle sprain (most significant risk factor).

• Weak peroneal muscles or delayed activation.

• Reduced proprioception and balance control.

• Poor footwear or unstable surfaces.

• Restricted ankle dorsiflexion or tight calf muscles.

• Pelvic or hip asymmetry, altering limb alignment.

• Foot overpronation or flat arches.

From an osteopathic perspective, chronic instability represents a loss of integrated movement control, often involving the pelvis, hip, and foot mechanics, not just local ligament laxity.

4. Osteopathic Approach

Osteopathic care focuses on restoring joint integrity, improving proprioception, and normalising kinetic-chain balance.

An osteopathic assessment may include:

• Evaluation of ankle mobility, swelling, and ligament integrity.

• Gentle mobilisation of the ankle, subtalar, and midfoot joints.

• Myofascial release of the calf, peroneals, and plantar fascia.

• Functional and indirect techniques to reduce residual strain.

• Mobilisation of the knee, hip, and pelvis to restore limb coordination.

• Proprioceptive retraining and guidance on progressive loading.

• Advice on balance exercises, footwear, and surface adaptation.

The goal is to restore stability through mobility and control, ensuring the entire lower limb supports efficient, pain-free movement.

5. Scientific Evidence & References

Research supports manual therapy, balance training, and neuromuscular rehabilitation as effective strategies for both acute and chronic ankle instability.
Evidence highlights the value of joint mobilisation and soft-tissue work in improving proprioception, mobility, and function.

Osteopathic care integrates these principles within a broader kinetic-chain framework, enhancing both recovery and prevention.

References

1. Hertel J. Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train. 2002;37(4):364–375.

2. Gribble PA, et al. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train. 2016;51(6):511–519.

3. Hoch MC, McKeon PO. Joint mobilization improves spatiotemporal postural control and range of motion in chronic ankle instability. J Orthop Sports Phys Ther. 2011;41(2):81–89.

4. Wikstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach. Sports Med. 2013;43(6):385–393.

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265.

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for ankle and foot pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865.

7. Bleakley CM, O’Connor SR, Tully MA, et al. Effect of manual therapy combined with exercise versus exercise alone after ankle sprain: randomised controlled trial. BMJ. 2010;340:c1964.

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for ankle instability: network meta-analysis. Front Pain Res. 2024;15:1507529.