Lateral Ankle Sprains in Dancers: Causes, Symptoms, Treatments
As dancers, we are always pushing to the edge of our limits, and sometimes beyond. Whether it be in drilling our techniques, rehearsing every night, or simply putting our all into a show, we leave it all on the floor and routinely sacrifice our bodies to the greater good of dance. What’s more, if we are ever in a position where we must choose between safety and aesthetics, well, this is hardly even a question.
Unfortunately, this leads to the risk of injury in dancers being relatively high compared to our counterparts in other sports. In fact, 90% of dancers sustain at least one injury over the duration of their career, whether it be social, amateur, or professional¹.
Many injuries are common in dance, and all can be debilitating; hip sprains, muscle strains, even fractures, but with 40% of dance injuries occurring below the knee, none are more impactful to a dancer than the lateral ankle sprain².
This blog will cover the following topics about Lateral Ankle Sprains:
- What is a Lateral Ankle Sprain
- Symptoms of a Lateral Ankle Sprain
- Causes of a Lateral Ankle Sprain
- Reducing the risk of a Lateral Ankle Sprain
- How can we prevent dance injuries?
- Treatments for Lateral Ankle Sprains
- So what do I need to know about Lateral Ankle Sprains?
What Is a Lateral Ankle Sprain?
A lateral ankle sprain occurs when the ligaments on the outside of the ankle are stretched or torn. These ligaments play a crucial role in maintaining ankle stability during dynamic movements. There are several ligaments involved in this injury, and the grade of injury describes both the number of ligaments injured, as well as the degree to which they are torn. A sprain is usually accompanied by swelling, and in the more severe cases, by bruising³.
Sometimes ligaments further up between the lower ends of the tibia and fibula (leg bones) can be involved. This is referred to as a high ankle sprain or syndesmosis injury. These injuries can be a bit more complicated - read our blog on ankle syndesmosis injuries for further info on that type of ankle sprain.
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Symptoms of a Lateral Ankle Sprain
If you do sustain a lateral ankle sprain, most people notice straight away. Pain is located around the outside ankle, called the lateral malleolus, and is usually just in front of and below the bone. It will be tender to touch at the joint, and if it isn’t, you almost certainly don’t have a lateral ankle sprain. The swelling is usually quite localised, forming a little pouch around the lateral malleolus. More severe sprains and other injuries cause swelling that spreads further, even to the inside of the ankle, up the shin, or into the foot. If there is bruising this is typically less localised, presenting anywhere from the mid-shin down, but often pools around the heel and foot.
Depending on the grade of injury, walking will be either uncomfortable or excruciating, but if you can’t walk even four steps it may be important to get an X-Ray to check for fracture⁴.
Causes of Lateral Ankle Sprains
Sustaining an ankle sprain is often just plain bad luck, but it is nonetheless important to be mindful of how we move. Rolling the foot in, or as it’s known in ballet, ‘sickling’, reduces joint stability and exposes the ligaments to potential overload, and is the mechanism involved in most lateral ankle sprains. This position is especially risky in certain actions like jumping, turning and spinning, as these moves involve high loads and leave very little room for error⁵.
When performing these moves it is therefore very important to stay controlled and balanced, and to avoid landing awkwardly, misstepping, and improper weight-transfer. If you are having difficulty with this, first talk to your coach or instructor to check any technique issues. If you still have trouble and aren’t sure why, you may have a movement control impairment or muscular imbalance that your physiotherapist can help with.
Reducing the Risk of Lateral Ankle Sprains
The single most effective way to reduce risk of lateral ankle sprain, or indeed any injury, is to engage in regular and consistent individualised exercise⁶. Group fitness classes or gym programs can help to a point, but are unlikely to be able to identify and address your own specific impairments⁷. At PhysioTec Dance Physiotherapy, we employ many tried and true methods to deliver this exact service.
If you can’t get an individualised exercise program, at least ensure you are training the muscles in your deep core, deep hip rotators, calves, and feet.
In addition to this screening and specific exercise program, optimising and maintaining general health is imperative. This means managing any known conditions, as well as ensuring sufficient nutrition and rest is achieved⁶. The nitty gritty detail of this is beyond the scope of this post, but check out the blog below, where we deep dived into injury prevention for dancers.
How Can We Prevent Dance Injuries?
The last thing to note on this is that injuries are more closely associated with the number of dance sessions per week, rather than number of dance hours. This means we can’t ‘increase rest’ by training for shorter durations each day, we need actual days off⁸.
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Treatments for Lateral Ankle Sprains
Lateral ankle sprains are notorious for their persistence. Unlike a fleeting muscle strain, they can linger for weeks or even months. What’s more, without proper management, 50% of lateral ankle sprains lead to chronic instability⁹. Physiotherapy assessment and management is crucial for the timely and lasting recovery from this injury, and we should continue rehabilitation until we regain as much or ideally more function than we had pre-injury¹⁰. This means we can’t safely rush back to our normal dance trainings, even if the pain is much less, until cleared to do so by our physiotherapist. Furthermore, it is not uncommon that other injuries are sustained in conjunction with a lateral ankle sprain, and diagnosing and treating these is required for full recovery.
So, what do I need to know about Lateral Ankle Sprains?
They are the injury responsible for the most dance hours missed, and can lead to long term difficulty if not well-managed. Regardless of your level of dance, you will benefit from addressing all the potential risk factors highlighted above to reduce your injury risk. If you do sustain this injury, see a physiotherapist straight away and we’ll help you recover as quickly as possible.
Is your ankle pain making it hard to move normally, or perform your dances? Visit us at PhysioTec, and let one of our physios provide an assessment and a personalised program to help you get on-top of that pain, and back to those favourite activities!
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This blog has been written by one of our experienced PhysioTec physiotherapists. If you would like to book with one of our physio's, call 3342 4284 or click here to book online.
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References:
- Ryan, A. J., & Stephens, R. E. (1987). The epidemiology of dance injuries. Dance Medicine: A Comprehensive Guide. Chicago, IL, Pluribus Press, Inc. and Minneapolis, MN, Physician Sportsmedicine, 3-15.
- Schafle, M., Requa, R. K., & Garrick, J. G. (1990). A comparison of patterns of injury in ballet, modern, and aerobic dance. Preventing Dance Injuries: An Interdisciplinary Perspective. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance, 1-14.
- Nuhmani, S., & Khan, M. H. (2013). Lateral ankle sprain—an update. Journal of musculoskeletal research, 16(04), 1330003.
- Pigman, E. C., Klug, R. K., Sanford, S., & Jolly, B. T. (1994). Evaluation of the Ottawa clinical decision rules for the use of radiography in acute ankle and midfoot injuries in the emergency department: an independent site assessment. Annals of emergency medicine, 24(1), 41-45.
- Russell, J. A. (2010). Acute ankle sprain in dancers. Journal of dance medicine & science, 14(3), 89-96.
- Russell, J. A. (2013). Preventing dance injuries: current perspectives. Open access journal of sports medicine, 199-210.
- Wang, F., Guan, Y., Bamber, Z., Cao, X., Qi, Q., Niu, W., & Chen, B. (2023). Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis. Clinical Rehabilitation, 37(5), 585-602.
- Lee, L., Reid, D., Cadwell, J., & Palmer, P. (2017). INJURY INCIDENCE, DANCE EXPOSURE AND THE USE OF THE MOVEMENT COMPETENCY SCREEN (MCS) TO IDENTIFY VARIABLES ASSOCIATED WITH INJURY IN FULL-TIME PRE-PROFESSIONAL DANCERS. International journal of sports physical therapy, 12(3), 352–370.
- Simon, J., Hall, E., & Docherty, C. (2014). Prevalence of chronic ankle instability and associated symptoms in university dance majors: an exploratory study. Journal of Dance Medicine & Science, 18(4), 178-184.
- Dhillon, M. S., Patel, S., & Baburaj, V. (2023). Ankle sprain and chronic lateral ankle instability: Optimizing conservative treatment. Foot and Ankle Clinics, 28(2), 297-307.