Ankle Sprains are one of the most common injury that graces emergency rooms across the U.S., in fact believe it or not, over 25,000 Americans sprain an ankle each and every day of the year. Most of us have not experienced a severe sprain that would entail the use of crutches, but nearly everyone has at one time or another experienced an inversion "rolled" ankle sprain.

The foot and ankle complex are made up of 29 bones not including the tibia and fibula or the sesamoid bones (accessory bones). These bones are held or tied together by connective tissues such as ligaments, tendons, muscles, and fascia. Why is this important to know? Because fixing injured connective tissues and the associated joint related injuries is what we do. You see, I am a joint expert. I know that is a lofty statement, but it matters not the diarthrodial (freely moving) joint is in the lower back, the neck, shoulder, knee or elbow. That is my specialty, having been trained at a College of Chiropractic as well as the Baylor Sports Medicine Institute, and it is my passion with practice experience of over 23 years and a second clinic opening in the Galleria.


Sooner or later, everyone is going to experience an ankle injury. What you do with that injury could make all the difference in the world between having the ability to function normally or experiencing a lifetime of chronic pain. The very first thing to remember even before going to the doctor is R.I.C.E.M.

  • REST: Rest does not mean that you should do nothing with an ankle for days or weeks on end after injuring it. It means that after you sprain your ankle, you need to get off of it right away to prevent further damage. It may mean you need to lay off of sports for awhile or get a pair of crutches for a few days. Self treatment is not advisable as you might have greater injuries than your ability to self diagnose.

  • ICE: This is a critical step in the healing process. Ice is a vasoconstrictor, meaning that it “constricts” arteriole blood flow at the site of injury and slows down inflammation. The inflammatory chemicals or exudates that are released via the injury process attract the fluid into the surrounding area and cause swelling. Some swelling and inflammation is a good thing and actually promotes proper healing. However, too much swelling causes, among other things, an eventual build up of scar tissue. I strongly advise not using anti-inflammatory drugs to deal with swelling because they have been scientifically proven to cause injured ligaments to heal 1/3 weaker, and about 40% less elastic. Not good for preventing recurrence!

  • COMPRESSION: Cellophane pressure wrap to control the amount of swelling that is taking place. This should only be done in our office as the pressure gradients if too tight can cut off circulation to the foot and ankle. Otherwise, an ACE bandage or ankle “sleeve” will suffice here. This simply helps keep swelling down. If there is swelling it is always advisable to get x-rays as avulsion fractures are quite common with this injuries.

  • ELEVATION: Elevation helps keep swelling down as well, but only if your ankle is elevated above your heart! Simply propping your foot up in a recliner is not good enough.

  • MOTION (CONTROLLED): Between icing intervals, fast and slow non-weight bearing plantar and dorsal flexion movements should be performed as that will initiate the first stage of healing so that the body will begin to lay down collagen fibers along the length of the ligaments, tendons and other collagenous connective tissues.

Ankle Sprains are Graded according to their severity (the amount of tissue damage that they cause.

  • GRADE I: A Grade I is a very simple injury. Tissues are “stretched” but not really torn. The prognosis for this type of injury is essentially 100%

  • GRADE II: A Grade II is a bit more severe. There is some tearing of the ligaments and tissues. There will be some of the standard features of an ankle sprain; swelling, heat, pain, a diminished ability to bear weight, etc. If these are dealt with the proper way, the prognosis is good, and healing and rehab will take a few weeks to a couple of months. If they are not rehabbed properly and they are left to occur over and over again the condition becomes chronic with an increase proliferation of scar tissue will result.

  • GRADE III: Grade III sprains are severe and the foot and ankle is very unstable. You will experience of a Grade II, only worse. You will likely spend some time on crutches, and the healing time will be measured in months. Your ankle will never be the same after a Grade III sprain. Proper rehab is absolutely critical as are chiropractic adjustments to improve joint functionality not only at the ankle but being that we are talking about a kinetic chain adjustment to the knee, hip and mid to lower spinal region are very often needed.

  • AVULSION FRACTURE: This is a fracture of the Fibular head which is the smaller bone the outside of the shin (Tibial) bone. An avulsion fracture of the ankle is not a fracture like you are probably thinking of. Ligaments and tendons anchor themselves to bones via microscopic Velcro-like “hooks” called Sharpey’s Fibers. When your ankle is twisted violently enough to pull ligaments and tendons off of bones, they usually take a tiny chunk of bone along with them. Sometimes these are big enough to show up on x-ray, sometimes they are not. An Avulsion Fracture is simply a Grade III sprain that has pulled small pieces of the bone away from their attachment points. This is a highly unstable fractured condition and should not be taken lightly and you cannot diagnose this yourself. Sometimes these require a cast, sometimes they do not. I have never had avulsion fracture but I have experienced Grade III ankle sprains in both ankles during high school sporting activities. Don't take it lightly, seek professional help because bone is the only tissue in your body that requires immobilization to heal properly. Soft tissues must have movement to heal properly, otherwise they heal with massive amounts of scar tissue. The more controlled and safe (within the margins of safe motion) the more synovial and other fluids bathe the inside the joint and the better the outcome or resolution of the injury.

The information found on this webpage is not a substitute for medical advice from a licensed physician or legal advice from a licensed attorney. Any concerns or questions related to your injuries or pain patterns whether acute or chronic, and their legal impact and consequences, if any, need to be conducted with appropriate legal counsel. Any concerns or questions related to your injuries and/or pain patterns whether they are deemed acute or chronic, and their short term or long term physical impact and consequences, need to be conducted with an appropriate licensed physician. The information found on this page is for informational purposes only and is not meant to diagnose, treat and/or educate for purposes of treatment and/or educate for the purposes in the self treatment of your injury or injuries or pain patterns.