Ankle Sprain

Introduction:

An ankle sprain is an injury to the tough bands of tissue (ligaments) that surround and connect the bones of the leg to the foot. The injury typically happens when you accidentally twist or turn your ankle in an awkward way. This can stretch or tear the ligaments that hold your ankle bones and joints together.

All ligaments have a specific range of motion and boundaries that allow them to keep the joints stabilized. When ligaments surrounding the ankle are pushed past these boundaries, it causes a sprain. Sprained ankles most commonly involve injuries to the ligaments on the outside of the ankle.

causes:
An ankle sprain often occurs when the foot suddenly twists or rolls, forcing the ankle joint out of its normal position. During physical activity, the ankle may twist inward as a result of sudden or unexpected movement. This causes one or more ligaments around the ankle to stretch or tear.

Some swelling or bruising can occur as a result of these tears. You may also feel pain or discomfort when you place weight on the affected area. Tendons, cartilage, and blood vessels might also be damaged due to the sprain.

Ankle sprains can happen to anyone at any age. Participating in sports, walking on uneven surfaces, or even wearing inappropriate footwear can all cause this type of injury

Symptomes:

swelling
tenderness
bruising
pain
inability to put weight on the affected ankle
skin discoloration
stiffness

Diagnosis:

a physical exam to determine which ligaments have been torn. During the exam, your doctor may move your ankle joint in various ways to check your range of motion.

Imaging tests, such as X-rays, may also be ordered to rule out a bone fracture. An MRI may be done if your doctor suspects a fracture, a serious injury to the ligaments, or damage to the surface of the ankle joint. The MRI test uses a strong magnetic field and radio waves to create detailed images of the body. This allows your doctor to make a proper diagnosis.

Treatment:

You may be able to treat mild sprains at home.
Recommended home care treatments include:

using elastic bandages (such as an ACE bandage) to wrap your ankle, but not too tightly
wearing a brace to support your ankle
using crutches, if needed
elevating your foot with pillows as necessary to reduce swelling
taking ibuprofen (such as Advil) or acetaminophen (such as Tylenol) to manage pain
getting plenty of rest and not putting weight on your ankle
It’s also helpful to apply ice to the injured area as soon as you can to reduce swelling. On the first day, you should apply ice every 20 to 30 minutes, three to four times per day. Afterward, apply ice every three to four hours for the next two days.

How u can lower your risk for future sprains by:

wrapping the affected ankle in an elastic bandage
wearing a brace, if necessary
performing strengthening exercises
avoiding high heels
warming up before exercising
wearing sturdy, quality footwear
paying attention to surfaces you’re walking on
slowing or stopping activities when you feel fatigued
Call your doctor right away if you think you’ve sprained your ankle again. When left untreated, an ankle sprain can lead to long-term pain and instability in the ankle.

Which Ankle Ligaments are Commonly Sprained?
Your ankle joint, known as the talocrural joint, is made up of three bones: the tibia (shin bone – inside ankle bone), fibula (outer lower leg – outside ankle bone) and talus (deep ankle bone). Underneath the talocrural joint lies the subtalar joint, which is the articulation between the talus and the calcaneus (heel bone).

Your ankle ligaments attach from bone to bone and passively limit the motion available at each joint.

On the outside of the ankle lie the lateral ligaments, which are the most frequently injured in an ankle sprain. These include the:

anterior talofibular ligament (ATFL)
calcaneofibular ligament (CFL)
posterior talofibular ligament (PTFL)
The main medial (inside of ankle) ligament is the much stronger deltoid ligament.

High ankle sprains involve the inferior tibiofibular ligament and syndesmosis. These are more disabling ankle injuries and are often misdiagnosed as the more simple sprained ankle.

Physiotherapy Treatment Aims

Injury Protection, Pain Relief & Control Inflammation
Regain Full Range of Motion
Strengthen your Ankle and Calf Muscles
Restore Joint Proprioception & Balance
Restore Normal Function
Speed & Agility
Sport-Specific Skills
Graduated Return to Training
Return to Competition

Sprained Ankle Treatment Progressions

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.

Phase 1 – Injury Protection: Pain Relief & Control Inflammation

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.

(Active) Rest: In the early phase you’ll most likely be unable to walk on your sprained ankle. Your first aim is active rest from pain-provoking postures and movements. This means that you should stop doing the movement or activity that provokes the ankle pain. In most cases, you will need to be non-weightbearing. You may need to be placed in an ankle walking boot, a supportive ankle brace or utilise crutches.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Compression: A compression bandage, tubigrip compression stocking or kinesiology supportive taping will help to both support the injured soft tissue and reduce excessive swelling.

sprained ankle treatment

Elevation: Elevating your injured ankle above your heart will assist gravity to reduce excessive swelling around your ankle.

A Range of helpful tricks including pain relieving techniques, joint mobilisations, massage, strapping and acupuncture to assist you during this painful phase.

Anti-inflammatory medication and natural creams such as arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reliever.

Phase 2: Regain Full Range of Motion

If you protect your injured ankle ligaments appropriately the torn ligaments will successfully reattach and heal a normal functional length. Mature scar formation takes at least six weeks. During this time period, you should be aiming to optimally remould your scar tissue to allow for full functional ankle movement and prevent a poorly formed scar that will re-tear in the future.

It is important to lengthen and orientate your healing scar tissue via massage and exercises designed to address your joint range of motion, muscle length and normal neural tissue motion.

Phase 3: Restore Muscle Strength

Your calf, ankle and foot muscles will require strengthening after an ankle sprain. It is important to regain normal muscle strength to provide normal dynamic ankle control and function. Your strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for your other leg, gluteal and lower core muscles depending on your assessment findings.

Phase 4: Normalise Foot Biomechanics

Sprained ankles can occur from poor foot biomechanics eg flat foot or high arch. In order to prevent a recurrence, your foot arch and its control should be assessed by your physiotherapist. In some instances, you may require a foot orthotic (shoe insert) or you may be a candidate for the Active Foot Posture Stabilisation Program.

Phase 5: Restore High Speed, Power, Proprioception and Agility

Most sprained ankle injuries occur during high-speed activities, which place enormous forces on your ankle and adjacent structures.

Balance and proprioception (the sense of the relative position of neighbouring parts of the body) are both known to be adversely affected by injuries such as a sprained ankle. To prevent a re-injury, both aspects need to be assessed and retrained.

In order to prevent a recurrence as you return to your sport, your physiotherapist will guide you through exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 6: Return to Sport

If you play sport and depending on the demands of your chosen sport, you may require sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

There is no specific time frame that sprained ankle recover. While we do know that the ligaments themselves will take at least six weeks to heal, your muscle strength, the range of motion, proprioception and return to function can vary considerably.

Some general guidelines:

Grade 1 – Mild

In mild cases, you can expect full ligament healing within 2 to 3 weeks, but it will take at least six weeks for full scar tissue maturation.

Despite most people being told to simply “rest” and it will recover, we find that these mild sprains often result in joint stiffness, ligament laxity, muscle weakness or tightness plus reduced proprioception (balance and joint awareness).

If not adequately treated these often cause your ankle and foot joints to compensate movement at adjacent joints, which can lead to several other injuries months or years down the track.

Grade 2 – Moderate

Grade 2 injuries occur when you have a significant ligament injury that allows the ligament to excessively stretch. In most cases, these injuries result in a recovery period of 4 to 6 weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive.

All Grade 2 injuries should be thoroughly rehabilitated to enable:

full range of motion and strength
full proprioception, power and agility
full return to sport-specific drills

Grade 3 – Severe

Grade 3 ligament injuries are when the ligament is completely ruptured. More severe ankle sprain injuries can also include fractures of the bones or high ankle sprains, which will require additional rehabilitation time to a simple lower ankle sprain.

The rehabilitation of a Grade 3 ankle sprain normally takes 6 to 12 weeks but is quite variable depending on your specific injury.

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