The ankle joint is made up of four bones shaped to make the joint stable. Increased stability of the joint is provided by ligaments, which are bands of strong, fibrous tissue that guide movement and prevent the joint from moving too much. An ankle sprain occurs when a sudden movement can overstretch the ligaments and muscles tearing these structures and causing some bleeding round the joint. The resultant symptoms can be severe pain and swelling. Common activities that may cause ankle sprains are soccer, rugby, and netball, running or even walking on an uneven path at night with poor lighting. The risk of an ankle sprain increases the more uneven the surface.
While most ankle injuries will settle well after a sprain without treatment a physiotherapist will be able to help determine the extent of the injury and if there are any complications. A diagnosis of the actual pathology will also need to be made. This is because there are many structures within the ankle that could be involved and each one will need to be addressed differently. These include numerous ligaments and the bones and joints and muscles themselves. Rehabilitation exercises and a good walking pattern can be implemented straight away and progressed as you improved to get you back to full function.
Even before you see any professional you should, as soon as possible, and for 72 hours after injury, use the PRICE method:
- Protect: You might use a bandage or crutches to prevent the ankle sprain getting worse.
- Rest: Take it easy and only move within your limit of pain. It is important to get walking as soon as possible so crutches are often used to help achieve a good walking pattern.
- Ice: As soon as possible, and for 20 minutes every two hours, apply ice or a frozen gel pack wrapped in a damp towel. This helps to control bleeding and pain and reduces secondary tissue damage.
- Compression: Firmly bandage the entire ankle and lower shin. This helps to control swelling. This should be firm but not restricting all the blood supply.
- Elevation: As much as possible, elevate your ankle higher than the level of your heart to reduce swelling.
All ankle sprains can benefit from an assessment and the application of clinical tests early to prevent complications and bring about a speedy recovery of all the symptoms. Your physiotherapist will need to assess and give you an idea of how bad the ankle sprain is. We use a grading scale to help with this.
- Grade 1: mild damage without instability of the affected joint
- Grade 2: a partial tear to the ligament
- Grade 3: a complete tear which will cause instability.
Remember though that there are many ligaments and that the stability of the ankle is dependent on all these ligaments and the muscles. So tears could involve a couple of structures involved in the support of the ankle.
The treatment that the physiotherapist applies will be determined by your symptoms and the pathology that has been identified. The immediate priority is to follow the PRICE procedure highlighted above. Crutches might be used to achieve pain free walking earlier. Limping is the cancer of ankle sprains and crutches and or taping will helps us achieve a better walking pattern much earlier. Joint mobilisations and soft tissue massage to the ankle will also be performed. These are staged according to your pain and should not hurt excessively. Exercises are started early and are progressed as you get better. Exercises will be to strengthen the muscles around the joint
It is very important that high level sport and work specific rehabilitation is implemented especially when the main reason why people re-sprain is in fact not a lack of strength or poor flexibility but because of poor balance (balance) under loaded situations. It is important to retrain under unstable conditions and with eyes closed with all the strengthening exercises.
So you have had a sprain, don’t let it become a second sprain or let it drag on beyond what it should normally take to heal. The evidence is clear untreated or poorly treated previous ankle sprains can lead to future sprains. Coastal Physiotherapy & Sport Injury Clinic is the leading Gold Coast Physio provider and will help you get back to your sport and normal life after that ankle sprain.