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Ankle Sprains

If you have ever played sports, there is a pretty good chance that you have had an injured ankle or at least seen someone who has.

Research suggests that sprained ankles are the most common musculoskeletal injury in the sporting population.

However, this injury is also more common than you may think in the general population.

You can sustain an ankle sprain while out on walks, working in the garden, chasing the dog and playing around with the kids.

Recurrence rates of ankle injuries are also very high, meaning that many of people end up having chronic ankle conditions.

For this reason it is extremely important to seek treatment early from the first instance.

An ankle injury occurs when the foot twists or rolls beyond it’s normal limits of the ankle joint putting the ligaments and joint under stress.

At a certain point these ligaments become over-stretched or damaged and thus an ankle sprain occurs.

The damaged ligaments then cause an inflammatory response resulting in ankle pain, swelling, redness and bruising around the joint.

It is important to rule out any ankle fracture or “Broken Ankle”.

You would be surprised how often a fracture is involved and missed thinking it’s just a common ankle sprain. 

Redness, swelling and bruising are common signs of an ankle injury!

Ankle injuries are typically talked about in grades:

Grade 1: Slight stretching and some damage to fibers

Grade 2: Partial tearing of the ligament

Grade 3: Complete tear or rupture of the ligament

Avulsion fracture. This occurs when the ligament pulls off a piece of bone before getting damaged itself.

Below is a diagrammatic representation of three grades.

Let’s discuss what makes up the ankle!

The ankle has ligaments on both the medial (inside) and lateral (outside) aspect of the joint.

These ligaments help stabilise the ankle joint and serve as a guide to direct ankle motion.

The most common injury is typically a lateral ankle sprain due to the make-up of the foot, our movement and the strength of the ligaments there.

Three ligaments help stabilise the ankle on the lateral side. These ligaments are:

  • Anterior talofibular ligament (ATFL),
  • Posterior talofibular ligament (PTFL) and the
  • Calcaneofibular ligament (CFL).

The ATFL is the most common ligament that is injured in a lateral ankle sprain.

On the medial side, the ankle is stabilised by the deltoid ligament which is made up of 4 ligaments and is extremely strong.

We have talked about lateral and medial ankle sprains but there is another type of ankle sprain that is also fairly common and misdiagnosed.

This is called a high ankle sprain.

A high ankle sprain occurs when there is damage to a different ligament called the anterior inferior tibiofibular ligament.

We’ll touch on this in a further blog!

Above is a picture of the bones and ligaments of the foot and ankle!

How is an ankle strain diagnosed?

Due to the number of structures involved in the make up of the foot and ankle, we will need to perform a full foot and ankle assessment to diagnose your injury.

This includes

  • Range of Movement Testing: to see how affect the movement is
  • Strength Testing of the muscles to see how weak or impaired they have become 
  • Proprioception Testing of the lower limb, foot and ankle to determine if your joint position sense is affected
  • Gait Analysis or walking or running
  • Special testing of the ankle ligaments  to determine which are injured and affected by the injury.

 

A knee to wall test will tell you if you have a restriction in ankle range of movement. Try it at home, if you have a difference side to side following injury then you need to get it moving! 

How is an acute ankle injury managed?

Treatment will always depend on the individual presentation of the patient however there are some things that you can do in the initial stages to assist with better outcomes.

As with most injuries it is important to follow the direction of a qualified health care provider.

There are some principles around soft tissue management for ankle injuries, you might have heard of some.

  • ICE (Ice – Compression – elevation) or
  • RICER (Rest -Ice – Compression – Elevation – Rehabilitation/Recover) or
  • POLICE (Protect – Optimise – Load – Ice – Compression – elevation)

 

But the latest is PEACE and LOVE!! (BJSM, 2019)!!

These principles apply for acute, sub-acute and chronic injuries or immediate care (PEACE) and ongoing care (LOVE).

Here is what they mean!

P.E.A.C.E

PROTECTION: from further injury for days to weeks post

ELEVATION: Higher than the heart as often as possible

AVOID ANTI-INFLAMMATORIES and ICE: They may slow tissue healing when used incorrectly

COMPRESSION: use elastic bandage such as tubi grip

EDUCATION: Understand your condition, gain advice from a reputable source

L.O.V.E

LOAD: Graded loading during tissue healing is important. Pain is respected but not feared!

OPTIMISE: Conditioning your brain for optimal recovery by understanding your condition, being confident that your body will heal and is designed to do just that.

VASCULARISATION: Choose pain free cardiovascular exercise early on to increase blood flow to repairing tissue/s

EXERCISE: plan rehabilitation and building back up to normal over time using mobility, strength, proprioception and adopting an active approach to treatment will increase confidence and normalise function again

Should I ice my ankle?

Despite the above, we are not completely against it, but not all injuries need to be iced.

Applying ice to the ankle may help with the pain management (analgesia).

A tip to remember is if ice assists you ensure that you let the ankle naturally return to body temperature before re applying.

More often then not people over do the ice part, either too cold or too long, expecting it to reduce swelling. It doesn’t!

Should I brace or immobilise the ankle?

In some cases, it will be important to immobilise the ankle for a period of time.

This is where we come in and after an in-depth assessment the therapist will indicate what form of immobilisation (ie ankle brace or moon boot) you need and for how long.

We will also determine if further investigations are warranted to rule out fracture or serious ligament or joint damage.

During the period of immobilisation it is also important to continue with some light mobility & exercises in order to limit ankle joint stiffness.

Again we will guide you through this.

Once this period of bracing is over we will then guide you through a graded program focusing on rebuilding ankle movement, strength and proprioception.

Depending on the severity of the acute ankle injury and pain, a boot or brace maybe prescribed early on.

PREVENTING an ANKLE INJURY

Sounds like wishful thinking, right?

Prevention is always the key, especially when it comes to ankle injuries.

There is a lot you can do to limit your risk of injury through an appropriate strength and conditioning program tailored for you sport.

But injuries just happen and can’t be avoided in life. It is what you do when you injured that matters.

Leaving an ankle to get better on its own, not rehabilitating it, half arsing and not finishing the full course of treatment and injury rehabilitation JUST because pain got better, WILL CAUSE ISSUES IN FUTURE!

Physiotherapy for a sprained ankle

If you have recently or in the past sprained your ankle and want a great outcome. 

Come on into the clinic and we will put you to work getting that ankle right again!

Above: Strength testing the muscles of the lower limb using our in house technology to track and monitor your progress!

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