Lateral ankle sprain

What it is

Three short ligaments hold the outside of your ankle together. The front one, the anterior talofibular ligament (ATFL), is tight when your toes are pointed down, which is exactly the position your foot is in when you come out of the air. When the foot lands tipped inward, that ligament takes the whole load and stretches or tears, sometimes taking the ligament below it (the calcaneofibular ligament) with it. Grades run from a stretched ligament with some swelling, to a partial tear, to a complete rupture, and the grade matters far more than how much it hurts in the first hour.

How volleyball causes it

Most bad ones happen on the centreline. A blocker lands blind with the eyes still up on the ball and puts the outside edge of the foot on the attacker's shoe as the hitter broad jumps forward across the line. Because the foot is already pointed downward coming out of the jump, it tips straight into a roll with nothing to stop it. The same thing happens between two blockers landing on each other in a double block, between a hitter and a covering teammate, and on a defender landing on a loose ball. Beach players roll ankles far less because sand collapses under a bad landing instead of gripping, while grass hides the same mechanism in divots and soft patches.

BlockingAttackingDefense

What it feels like

• A pop, snap, or tearing sensation felt at the moment of landing
• Swelling on the outside front of the ankle, often within minutes and often shaped like an egg
• Bruising that shows up over the next few days and tracks down into the foot and toes as gravity pulls it
• Pain putting weight through the foot, especially pushing off for the approach or shuffling sideways
• A feeling that the ankle is loose or will not hold when you turn on it

Stop and get it seen if

• You cannot take four steps on it right after the injury, or bone hurts when pressed on the back edge or tip of either ankle knob, on the navicular, or on the bump at the outside of the midfoot. These are the standard signs that an x-ray is needed to rule out a fracture.
• Numbness, pins and needles, or toes that go pale, dusky, or cold, which suggests nerve or blood vessel involvement and needs same-day care
• Pain high on the outside of the shin near the knee alongside the ankle pain, which can mean the fibula broke up top (Maisonneuve injury) even though the ankle is what hurts
• Obvious deformity, or the foot looking out of line with the leg
• Redness and heat spreading up the leg, or fever, which points to infection rather than a sprain

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Protect and settle

   3 days to 2 weeks

   Get the swelling under control and get walking normally again, once a fracture has been ruled out.

   • Swelling stops climbing and the ankle no longer feels tight and hot by the end of the day
   • You can put full weight through the foot and walk indoors without a limp
   • Bruising appears in the foot and toes, which is normal drainage rather than a new injury

2. 2. Motion and strength back

   1 to 4 weeks

   Get the ankle bending forward again and get the calf and the muscles down the outside of the shin working.

   • Kneeling toward a wall, the injured ankle bends forward close to as far as the good side
   • You can rise onto the toes of the injured leg alone without holding onto anything
   • Standing on the injured leg no longer needs constant clawing with the toes to stay upright

3. 3. Jump, land, and cut

   2 to 6 weeks

   Reintroduce impact and direction change so the ankle learns to absorb landings again.

Ready to play again when

• Single leg hop distance and side to side hop speed within about a tenth of the uninjured leg
• Balance on the injured leg with eyes closed for about half a minute, matching the other side
• A full block jump landed on a soft or uneven surface with no wobble and no apprehension
• No swelling or stiffness the morning after a full practice
• You stop thinking about the ankle mid-rally

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Wear a lace-up ankle brace, or get taped, for practice as well as matches. This is the single most effective thing in the sport, especially for anyone with a previous sprain, and most sprains happen in ordinary training volume rather than on match day.
• Single leg balance progressions: barefoot on the floor, then on a folded mat or foam pad, then with eyes closed, then catching a ball tossed off to one side. Game landings are blind, so training balance while your eyes are busy is the whole point.
• Band eversion work, turning the foot outward against resistance, plus side-lying eversion holds. The peroneal muscles down the outside of the shin are the active brake against a roll, and they only help if they are strong and quick.
• Heavy calf raises with the knee straight and with the knee bent, including slow lowering off a step. A strong calf controls how hard the foot slaps down out of the air.
• Blocker footwork drills that finish with a squared two-foot landing behind the line rather than a reach under the net, and hitters practising a landing with feet together instead of a splayed stride across the centreline.
• Glute and hip abductor strength, because a hip that collapses inward on landing tips the whole leg over the outside edge of the foot.