Pain and your Brain / High Ankle Sprains

The Relationship Between Pain and Your Brain

For someone suffering from pain, to be told “It’s all in your head” can be a frustrating experience. It is also a poor explanation of what is going on. What many people don’t understand is that pain is a complex process and the mind plays a role in the perception of pain for everyone.

All pain, no matter the cause, must be recognized by the brain and processed for you to be aware of it. Pain is actually an important part of human survival, letting you know which activities are dangerous and encouraging you to rest and in many cases to protect damaged tissue. When the body loses the ability to perceive pain, this can lead to further injury and even death.

There is a famous condition where people don’t feel any pain at all, known as “congenital analgesia”. This is actually a very dangerous condition and these people are at risk of dying young. They have no warning system letting them know that they need to seek treatment. It can be hard to get your head around the idea that pain helps you survive, but it really is an important strategy of our bodies to keep us protected.

Pain isn’t always associated with tissue damage.

Even though pain is an important part of human survival, sometimes things go wrong. A famous example of this is phantom limb pain, where amputees continue to have severe pain, sometimes for decades after the limb has been removed.

Sometimes pain can even be felt on the injured side when looking at a mirror image of their uninjured limb moving!!

The amount of attention you give to pain and how you feel about it will also change how severely you experience that pain.

Have you ever noticed a bruise and couldn’t remember how you got it? That is an experience of tissue damage without much pain. On the flip side, if you have suffered recent emotional trauma or are grieving you might find a small injury very difficult to deal with. Some people believe the best way to deal with pain is to ignore it and push through with all activities. Other people believe that the best treatment for all pain is to rest and stop all activities.

What you believe about pain and how you react to it can have a big effect on how your brain interprets pain signals. Feeling in control of your pain is also very important. For people who are experiencing pain for long periods of time without any way to reduce symptoms this can be very distressing, particularly if this pain is impacting their ability to participate in activities.

Your therapist is trained to help you deal with pain in the best way possible. This may involve counselling and education about how to deal with your pain and not just physical treatment of your injury. Don’t hesitate to ask us more next time you come in.

High Ankle Sprains


The ankle consists of three bones, the tibia, fibula and talus, all held together by thick fibrous ligaments. At the bottom of the leg they form a mortise or hinge joint with the foot. The bottom parts of the tibia and fibula join together and surround the talus in such a way that it is able to hinge forwards and back while providing stability and restricting the side-to-side movements.

Syndesmosis describes the ligaments holding the tibia and fibula together and a high ankle sprain is a tear of these ligaments. A normal ankle sprain is a tear of the ligaments lower in the ankle, and this is why we refer to a syndesmosis tear as a “high” ankle sprain.


These injuries usually occur through twisting of the ankle during sport, however they can also happen with day-to-day activities. The foot is typically pushed back and rotated outwards, putting excess pressure on the ligaments keeping the lower leg bones together. This force can cause the syndesmosis to tear resulting in a gapping of the two bones, which can lead to significant instability of the ankle.


High ankle sprains are much rarer than lower ankle sprains, accounting for only 1-11% of all ankle injuries. It can be very difficult to tell the two injuries apart. To complicate things, a fracture of the ankle will also have similar symptoms. Your physiotherapist will have a set of physical tests they can perform if they suspect a high ankle sprain. Ultimately imaging may be required to confirm the diagnosis.


High ankle sprains can take up to two times longer to heal than normal ankle sprains and require more immediate attention. Syndesmosis tears that are left untreated can result in chronic instability and pain, making them vulnerable to further injury in the future.


Severe and unstable tears may require surgery and most syndesmosis tears will need to be put into a supportive boot for 4-6 weeks. Following this period a rehabilitation program of strengthening, mobilization, balance, control and agility will need to be commenced before your ankle will be at its pre-injury function. Cortisone injections may be recommended in some cases and have been shown to have good results, when accompanied with proper rehabilitation program. Speak to your physiotherapist for more information.

None of the information in this newsletter is a replacement for proper medical advice. Always see a professional for advice on your individual injury.

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