What is an Ankle Sprain?
Ankle sprains are very common in sports. Physiotherapists describe an ankle sprain as an injury to the ligaments of the ankle joint. The ligaments are strong bands of tissue that are attached to the bones above and below the ankle joint. They provide stability and support to the joint itself.
There are two main sets of ligaments that can be injured in the ankle. One set is located on the inside (medial) and the other on the outside (lateral) aspect of the ankle.
A sprain occurs when one or more of the ankle ligaments is stretched or torn. In more severe injuries, the ligament can be torn from its site of attachment to the bone. A ligament that is stretched or torn is longer than normal and this increased laxity can make the ankle joint unstable.
What Causes an Ankle Sprain?
According to Physiotherapists, an ankle sprain happens when the ankle is forced inwards or outwards past its normal range of motion. This can occur when the foot lands awkwardly on an uneven surface when running or jumping. It can also occur during sports when the foot is firmly planted on the ground and the upper body continues to move.
When the ankle is forced outward, Physiotherapists refer to the injury as an eversion sprain. When it is forced inward, the injury is known as an inversion sprain. Inversion sprains are much more common than eversion sprains.
How are Ankle Sprains Diagnosed?
At Nose Creek Sport Physiotherapy, sprains are diagnosed on the basis of the history and physical examination. Tearing of a ligament is accompanied by bleeding into the surrounding tissues. Because of this, Physiotherapists assess levels of swelling, bruising and tenderness over the site of the ligament attachment.
The extent of these findings depends on the severity of the ligament injury, which Nose Creek Physiotherapists classify as grade 1, 2 or 3.
Grades of Ligament Injury
Grade 1 – minor ligament stretching
Grade 2 – moderately severe ligament stretching
Grade 3 – complete disruption of the ankle ligaments
X-rays do not diagnose ligament injuries, but are often obtained to ensure there is no injury to the joint or surrounding bone.
How are Ankle Sprains Treated?
The exact treatment at Nose Creek Sport Physiotherapy depends on the severity of the sprain and the presence of any associated injuries. Each Physiotherapy treatment plan is individualized through discussions with you and your Physiotherapist, and progress should be monitored regularly. Treatment takes place in 3 phases.
Physiotherapy Phase 1 – Control Pain & Inflammation
Research has shown that the amount of disability from an ankle sprain largely depends on the amount of swelling and inflammation. It is essential that treatment to protect the joint and minimize further swelling begin as soon as possible. This is accomplished by following the PRICE guidelines.
P Protect the joint from further injury with a splint and/or crutches
R Rest the joint as much as possible by avoiding weight bearing
I Ice as often as hourly
C Compress the injury by applying a wrap or tensor bandage intermittently
E Elevate the joint to reduce swelling
Ice is the method of cold preferred by most Physiotherapists and should be applied for 15-20 minutes as often as every hour. The bag of ice should be placed directly over the injury, preferably held in place with a wrap.
Tensor bandages or other tight wraps should never be left on overnight since they can obstruct the circulation. Anti-inflammatory medications may be very useful during this phase to control pain and limit swelling.
The duration of Phase 1 depends on the severity of the injury and ranges from several days to 1 week.
Physiotherapy Phase 2 – Restore Strength & Function
As the pain and swelling subside, Phase 2 Physiotherapy treatment should be continued. At Nose Creek Sport Physiotherapy, range of motion exercises begin with light, partial weight bearing. Exercises to strengthen the major muscle groups around the ankle are started and continue until full return to sport. Specific exercises to restore balance are also prescribed. All of these exercises are an essential part of the healing process and should be performed in a graded fashion, under the guidance of your Physiotherapist.
During this phase, your Nose Creek Physiotherapist will design a modified activity program to maintain cardiovascular fitness. The exercises selected should avoid loading of the ankle.
Physiotherapy Phase 3 – Return To Exercise & Sport
As symptoms subside, a return to exercise and sport can begin. This is accompanied by start and stop, figure-of-eight and cutting drills. Each individual progresses through this Physiotherapy Phase 3 program at their own speed, depending on the extent of the injury and the type of activity or sport they are resuming.
An ankle brace or taping can be very useful during the return to sport phase.
Can Ankle Sprains be Prevented?
To some extent ankle sprains can be prevented. The muscles supporting your ankle joint can be strengthened through a specific exercise program. Nose Creek Physiotherapists suggest that doing coordination and balance exercises may help prevent injury. If your ankle is unstable or if you participate in a sport with a high frequency of ankle sprains (soccer, basketball, football, etc.) an ankle brace or taping may help to prevent an injury.
Are there any Special Considerations?
Occasionally the inside surface of the ankle joint itself can be injured during a sprain. This may not be apparent at the time of injury but can lead to delayed recovery and may require additional tests.
Particularly severe or recurrent sprains can lead to chronic instability of the ankle joint. If this condition does not respond to strengthening of the muscles which support the ankle or bracing, surgery to reconstruct the ankle ligaments may be required.
A key point with acute sprains is that the severity of the disability from the ankle sprain is directly linked to the promptness of treatment. Phase 1 Physiotherapy steps of icing, elevation and compression should begin immediately.