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The Common Ankle Sprain

One of the most common sports injuries that will often go untreated is the common ankle sprain.  Most people have had experience with a sprained ankle, unfortunately, most do not realize that the lack of appropriate management can lead to recurrent ankle sprains and in some instances long standing (and annoying) ankle pain.  A major cause of re-injury is due to decreased proprioception after the ligament is torn.  Proprioception is related to your balance receptors and the ability to tell what your ankle is doing when you aren’t paying attention to it.  We will revisit this concept later.

Ankle Sprain Basics

Due to the forces that it withstands and the mass it supports, the ankle joint is often the tennis, squash, soccer, basketball, volleyball… player’s demise.  On the outside of the ankle, there are three major ligaments: the anterior talofibular ligament (ATFL), the posterior talofibular ligament (PTFL), and the calcaneofibular ligament (CFL). The common ankle sprain, also known as an inversion sprain, and usually involves injury to the ATFL and CFL.  These sprains occur when one “rolls” their ankle.

Inversion Ankle Sprain – The rolled ankle

When you roll your ankle, it is in a position of excessive inversion and plantar flexion. Your foot can be put in this position in a number of different situations including running on an uneven surface, losing one’s footing or landing from a jump awkwardly. Putting weight on the foot when it is in this position can stretch and/or tear the ATFL and CFL ligaments.  Ligaments maintain the stability of a joint through their connections from bone to bone.  Taking a joint beyond its normal anatomical range of motion leads to tearing of the ligaments.  The amount of tearing is referenced as a grade of ankle sprain.  These grades range from a small tear, grade one, to a total rupture of the ligament, which is known as a grade three or 3rddegree sprain.

How do I know if I have an inversion ankle sprain?

In the first few minutes following the injury it is likely that you will experience pain, tenderness, swelling, and bruising.  You may initially be able to walk and as the swelling increases you may have more difficulty.  As the swelling increases and spasm sets in, you will have difficulty with normal motion of the ankle.  This is all normal for an ankle sprain.

A sprained ankle and an ankle fracture are sometimes difficult to differentiate.  If you have an inability to walk on the ankle, numbness in the toes, and/or excruciating “lightning like” pain then you can suspect a fracture. If you do suspect a fracture then you should seek medical attention and a doctor will determine whether or not an x-ray is needed.

 What should I do?

If you suspect an ankle sprain you should take immediate measures to follow the RICE principle; RICE stands for rest, ice, compression, and elevation. RICE can help to prevent excessive swelling and facilitate the rehabilitation process. When using ice, you should always avoid direct contact with the skin; wrapping an ice pack or ice cubes in a damp towel works well. It is recommended to not leave the ice on for more than 20 minutes every few hours. You can compress the ankle with a tensor bandage and try to keep the ankle elevated above the heart as much as possible.  Simple motion exercises such as moving the ankle to perform the alphabet will help initially with stiffness, but in the initial stages aggressive stretching is not recommended.  Remember in the acute stage of a ligament sprain the R stands for rest and not for stretching.

Most people will think that their ankle is better when the pain goes away.  As the swelling subsides, the pressure on the pain nerve endings decreases and the pain goes away.  This does not mean that the ankle is better.  It feels better, it moves better but it has not healed and it is not stable yet.

Treatment

Receiving the proper treatment is vital so that the ankle heals properly, avoiding chronic pain and most importantly, re-injury.  A comprehensive treatment program may include ultrasound, IFC, taping, range of motion exercises, muscle strengthening, mobilization, Graston Technique, and even acupuncture for chronic conditions.  Treatment should commence immediately (within a few days), as physiotherapy can assist with swelling, regaining ROM, protecting the joint and alleviating pain.

As you progress, you should learn how to retrain your proprioception to decrease the chance of re-injury.  We focus heavily on training the lost balance that affects the ankle joint.  The muscles, ligaments, and joint capsule all have receptors that contribute to communicating with the brain about what the ankle is doing (proprioception).  When the ankle is sprained, these receptors are damaged and the connection is diminished.  If we don’t restore this proprioceptive ability, you may find that something as simple as stepping on a crack leads to another ankle sprain.  We lose the awareness that the ankle is rolling and by the time our body is able to react, it is too late.  Balance/proprioception is essential to the recovery of ligament injuries.

We also utilize many techniques to prevent the excessive deposit and encourage the proper structuring of the scar tissue.  Unfortunately, if the scar becomes fixed, thickened or immobile, it can affect the normal motion of the bones during functional movements.  This is one of the other reasons that ankles can become a problem long after the injury seems to have healed.

Source: Leading Edge Physiotherapy

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