All it takes is a simple mis-step, or landing on uneven ground, the ankle rolls in, and you've sprained it.
Ankle sprains are the most common sporting injury - they can occur from a quick direction change on a pitch, but equally just walking and hitting uneven ground can do it (or if you're like me, running to catch a dart!!). Because it is so common, people often underestimate it's impact - ankle sprains come with a high risk of re-sprain, but also the side effects of an ankle sprain could ultimately lead to other issues such as knee or back pain.
What is an ankle sprain?
It is a tear of the ligaments at the side of your ankle. These ligaments keep your ankle joint stable.
The most common way to sprain your ankle is by going over on your ankle by the foot rolling in (see picture), tearing the ligaments on the outside of your ankle.
When you tear them, you tend to get bruising and swelling, as well as pain. Sprains are graded 1-3 in terms of severity:
Grade 1 is mild, with some overstretching and possibly some fibres torn in the ligament. Recovery time tends to be about 1-3 weeks.
Grade 2 is a partial tear of the ligament (s). Usually 6 weeks until fully back in action.
Grade 3 is a full rupture of the ligament (s). These can take a few months until fully back.
Should I strap my ankle or use a brace?
You will hear of ankles being strapped, or wearing a brace to get back to playing sports sooner. These can certainly facilitate an earlier return to activity, but shouldn't be used as a stand alone - the ankle ultimately needs to be able to function without any support. Bad grade 2 or grade 3 sprains may require an orthopaedic boot or splint in the initial stages.
When do you need an x-ray?
The Ottowa Ankle rules decide this - if the ankle sprain fulfills any of these criteria, the ankle should be x-rayed:
- tenderness on the bone of the tip of the inner or outer ankle bones.
- an inability to weight-bear both immediately and in A&E for 4 steps.
How do I treat an ankle sprain?
1. Early management:
For initial management of the painful, swollen ankle, the old R.I.C.E. acronym is a bit outdated - I've written about this here
It is important to start gentle ankle movements as early as they are tolerated - this is usually within the first 2 days. Up/down/in/out/circles/writing your name in the air all get the ankle moving.
Calf stretches once tolerated are also good to do.
3. Strength and Balance
Beyond that, it is crucial to strengthen the ankle after injury.
Any injury to the ligaments causes something called Arthrogenic Muscle Inhibition (AMI for short) - decoded, this means that the injury causes the muscles around it to switch off. This affects our balance too, and can also cause weakness up the leg as far as the hip muscles.
So it is important to address this, and start rehab as early as possible - in the initial stages this is quite gentle to suit the injury - an example of an early exercise is this:
It is also important to get all of the muscles and tendons around the injured ligament strong enough again for the demands of the activity the ankle will get back to - a tennis player for example would need to get their ankle stronger than someone who just wants to get back walking. Both need to be sufficiently strong to reduce to risk of respraining.
Don't let your ankle become a "weak ankle"
What we are trying to avoid after an ankle sprain is what we call Chronic Ankle Instability - this is the "weak ankle" that is often turned or sprained - sometimes painfully, sometimes not. But a nuisance at best, and causing huge impact at worst. Research has shown that rehabilitation programmes addressing strength, mobility and balance dramatically reduce the risk of ankle re-sprain.
So bottom line on ankle sprains is:
Don't underestimate them - common doesn't mean they don't matter! Ankle sprains can have a really big impact. Get in touch if any of the above rings true for you, at 0404-49781, email firstname.lastname@example.org, or book online at https://www.eastcoastphysio.ie/booking