The Sprained Ankle

The sprained ankle is probably the most common of all sporting injuries. These injuries often occur in activities involving rapid changes of direction especially on uneven surfaces. The sprain normally affects the lateral (outside) ligaments of the ankle. These ligaments are much thinner and therefore more vulnerable than those on the medial (inside) of the ankle, hence the reason that most ankle sprains involve the lateral ligaments. The usual mechanism of lateral ligament injury is inversion (foot rolling in) and plantarflexion (toes pointing down). This may be accompanied by an audible snap, crack or tear. Depending on the severity of the injury, you may have been able to continue your activity or have been forced to rest /stop. Swelling soon after the injury is normal, but it can be delayed by some hours.

There are three grades of sprain that we talk about when assessing the injury. Grade I represents a minor tear with pain produced on stressing the injury but no laxity. Grade II injuries are painful on stressing the ligament and show some degree of laxity on examination but have a firm 'end' feel. (This is basically the feel you get when the ligament comes to the end of its flex, therefore stopping the joint from moving any further) Grade III injuries show gross laxity without a discernible 'end' feel. There can be pain or no pain with this grade.

The management of lateral ligament injuries of all three grades follows the same principles:

Initial Management

The initial management of lateral ligament injuries requires the RICE (Rest, Ice, Compress, Elevate) regimen. This is probably the most important factor in treatment. Icing should be done for 20 minutes every two hours and for at least the first 48-72 hours. Most of the problems resulting from ankle sprains come from the presence of blood and swelling in and around the joint, so it is important to avoid things that promote blood flow and swelling such as hot showers, heat rubs, alcohol and excessive walking.

Reduction of Pain and Swelling

This can be done with the help of electrotherapeutic modalities and gentle soft tissue therapy by a physiotherapist. Anti-inflammatories are also usually prescribed, but icing and rest are more effective than the tablets.

Restoration of Full Range of Movement

Sometimes you will be recommended to be on crutches for 24 hours, but normal walking should be encouraged ASAP. This can be achieved with strapping of the joint so that it moves only in a front to back plane and not the painful side to side motion.

Muscle Strengthening

Strengthening exercises should be performed as soon as pain allows. There are a number of exercises from the very basic calf raises to the more difficult theraband exercises that can be done. Your physiotherapist can recommend the best exercise for you.

Restoring Proprioception

This is one of the more important steps that people forget. Have you ever wondered why you continue to sprain the same ankle? Once you stretch a ligament or a muscle, the stretch receptors in these structures become altered. These structures need to be retrained so that they remember normal movement again. Proprioception is the mind knowing where the joint is subconsciously. If this is altered then the joint doesn't perform properly, leaving it more vulnerable to injury. Balancing exercises such as standing on one leg with your eyes open first, then eyes closed as you get better, are a good start to retraining your proprioception.

Return to Activity

Depending on the level of activity that you require, you may need to do sport specific exercise to check you are ready to return to your sport. These should be functional and require some of the movements your sport does. (e.g. jumping, hopping, sidestepping etc) Sometimes an athlete can require some form of strapping or bracing for all future activities. The correct strapping technique can easily be taught and good sports strapping tape is readily available nowadays.