Ankle sprains are one of the most common injuries, and almost everyone has experienced the fright of twisting or ‘rolling’ your ankle and the pain and inconvenience that accompanies it.
While a significant number of ankle sprains occur while playing sports, hurting your ankle can occur pretty much anywhere – walking on uneven surfaces, falling or slipping on stairs or just a sudden twisting movement.
Usually, the ankle is injured when the ankle rolls inwards (inversion) too forcefully and as a result, the ligaments along the outside of the ankle are overstretched and then tear.
Ankle sprains often reoccur at a high rate, especially if rehabilitation of the first injury is not sufficient in strengthening and repairing the ankle.
The ankle may be left weak and unstable, leaving it susceptible to further sprains, even during slow, simple activities such as walking.
Assessment of Ankle Sprains
The first important part of assessing an ankle injury is to determine whether there is a fracture.
When the ankle rolls, a pop or a crack may be heard, which can sound horrific, but this is most likely the sound of the ligament tearing.
Fortunately, ankle fractures are quite rare, but an x-ray may be requested if there is excessive swelling, inability to put weight on it, or if there is extreme tenderness around the inside and outside bone protrusions or toes.
Management of Ankle Sprains
There are three phases of managing a sprained ankle, to initially focus on immediate treatment and then further rehabilitation to restore the ankle.
A Sports Physiotherapist who is specialised in ankle and foot injuries can assist with the entire treatment of an ankle sprain and have you back up and pain free in no time.
Phase 1 – Acute Management
The first phase is to control the pain and swelling, and gently restore movement of the foot and ankle.
This may involve strapping or bracing, or even putting the foot in a moon boot if it is extremely painful and has a significant tear.
It is often the swelling that causes the pain. Swelling is excess fluid in the joint and tissues which increases pressure.
Elevation of the ankle and a long compression sock will often be used to reduce the swelling.
It is not recommended to use anti-inflammatory medication in the first three days of an ankle sprain as they can affect the healing response of the tissues.
The body needs a period of time after injury for natural inflammation to occur. Taking anti-inflammatories can cause weaker scar tissue to form.
Swelling may also be reduced by walking in water (level with your heart or higher) as the pressure of the water encourages any fluid in the ankle joint to be pushed out into the venous system – the veins that return blood to the heart.
Phase 2 – Restoration
As the swelling reduces the ankle may begin to feel stiff and restricted in movement so a physiotherapist may use massage, joint mobilisation and certain exercises to get the ankle’s range of movement back.
It’s important that the ankle is returned close to its normal full range of movement or the biomechanical chain in the leg (how it all joins together and functions) could be affected and then lead to further issues in the foot, knee and hip.
The muscles in the injured ankle may have ‘switched off’ from the pain and will likely have become weaker. A rehab program with a physiotherapist will really focus on this and help to regain strength in both the ankle and calf.
Other factors affected by an ankle sprain are your balance and your proprioception.
Proprioception is your sense or perception of your body movement and position – for example, knowing what position your joint is in without having to look at it. If this is not restored to an equilibrium, it can lead to an ongoing loss of balance or reactions.
Phase 3 – Exercises
Once most of the deficits treated in phase 2 have been attended to and have improved, returning to exercise can be looked at.
Exercises may initially include such smaller movements such as skipping, hopping, running and jumping – which simulate sporting activities.
Balance work in the air (someone pushing you while you’re mid-jump) and practicing to land may also be included.
Further on, these activities can be carried out while changing direction or going backwards and will help your ankle get used to a full range of movements again.
Once your ankle is strong enough, a gradual return to full activities and sports is recommended to continue to build up strength and resilience.
It is important you seek treatment for a sprained ankle as soon as possible. A fully trained physiotherapist at Melbourne Sports Physiotherapy will be able to determine a treatment plan specific to your needs and the pace of your recovery. The correct treatment and some determination will have you back to your active self before you know it.