17/5/2017, James Coller. PPS Physiotherapy, Physiotherapist
Have you ever rolled your ankle?
Do you have feelings of chronic instability?
Have you rolled your ankle more than once over the past couple of years?
Most of you would answer yes to one if not all of the above questions! So why are these types of injuries so common and why is it common to repeatedly sprain the same ankle in a relatively short period of time.
The Facts:
- Ankle sprains account for up to 10-20% of injuries in most sports
- 75% of people who have an ankle sprain have had one before
- You are twice as likely to re-sprain your ankle in the 12 months following injury
A ‘rolled’ or sprained ankle is one of the most common injuries seen in the physio clinic or on the sports field. This type of injury occurs when the ankle rolls outwards (inversion) during activities such as landing from a jump, side stepping or simply walking on uneven ground. Sometimes you may feel a crack or tear sensation followed by swelling and bruising around the outside of your ankle and it may be difficult to walk on.
So let’s have a look at how you can manage a sprained ankle and how you can prevent chronic ankle instability…
Anatomy – what’s going on…
Firstly it is helpful to look at what happens during a sprained ankle to understand why it is black, blue and swollen and why we do what we do when we are treating you in the clinic!
There are two main ligaments that are sprained during an inversion injury. These are the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL).
When walking and running etc these ligaments contribute to the stability of the ankle and prevent it from rolling outwards. When this mechanism fails the ligaments are stretched and may partially tear and if stretched far enough will eventually completely tear or rupture.
How bad is my ankle sprain?
Ankle sprains are generally classified into 3 grades:
- Grade 1: minor micro-tearing of ligament fibres. Can often return to full activity in 1-3 weeks.
- Grade 2: significant but incomplete tearing of the ligament. Normally requires 4-6 weeks rehabilitation prior to full activity.
- Grade 3: rupture of the ligament. This may require surgery and can also result in fractures around the ankle joint. Recovery can range from 6-12 weeks.
What can I do to manage my sprained ankle?
R.I.C.E.R – Initially it is important to Rest, Ice, Compress and Elevate the ankle to minimise swelling and bruising and prevent any further damage. Depending on the severity of the injury Referral to a Physiotherapist or an x-ray may be required, particularly if there is significant pain and inability to walk on the ankle.
Move – Once pain allows it is important to begin movement of the injured ankle. Early movement has been shown to reduce the rates of long term issues with joint pain and stiffness. This may begin by gradually increasing walking as well as simple exercises such as ankle pumps before incorporating a range of exercises to regain full range of motion.
Muscle conditioning – following ankle injury it is important to strengthen the muscles surrounding the ankle to allow for better stability of the joint reducing the chance for injury in the future.
Proprioception – describes receptors in the body’s ligaments which send information to tell the brain where a joint is in space. For example, as the ankle starts to roll outwards these receptors will let the brain know this is happening to then make sure the ankle is rolled back into a normal position. Studies show that during ligamentous injury proprioceptors are damaged and need re-training to prevent further injury. This can include exercises such as single leg balance, standing on uneven surfaces, hopping, jumping and sidestepping.
Functional exercises – once you are pain free and have full range of motion it is vital to begin functional re-training. This may include sports-specific exercise, running and jumping.
What causes Chronic Ankle Instability and what can I do to avoid it?
In a number of ankle sprains there can be ongoing symptoms such as pain, recurrent instability, swelling after exercise and impaired function greater than 6 weeks post injury. This can be explained by the following:
- Incomplete ankle assessment
- There are a number of other issues that can occur with an ankle sprain besides the injured ligaments. There are a number of bones around the foot and ankle that can be fractured during ankle sprains as well as other impairments such as bone bruising, impingement, tendon injury, syndesmosis sprain to name a few. Thus it is very important to have a mild-severe ankle injury assessed by your Physiotherapist to ensure that these more serious injuries can be ruled out and your rehabilitation will be successful!
- Poor rehabilitation
- There are a number of factors described above which are vital to fully rehabilitate the ankle. By simply waiting until the ankle ‘feels’ better before returning to activity you put yourself at risk of re-injury.
- Returning to sport too early
- You are more likely to re-sprain your ankle within 12 months of the initial injury, therefore by returning to sport or activity before the ankle has full strength, range of motion and is stable during dynamic movement there is even greater risk of re-injury. Your Physiotherapist will guide you through a return to sport program and perform some specific tests to ensure your ankle is ready for your particular sport!
- Poor proprioception
- As described above this is a key factor to preventing further injury in ankles. Your physiotherapist can assess and prescribe a number of exercises to specifically target this area.
If you are still suffering from pain or loss of function after 3-4 days post injury then it is beneficial to seek treatment from a physiotherapist.
So next time you sprain your ankle make sure you book in to see one of our Physiotherapists to ensure a proper rehabilitation and stop yourself from suffering another one down the track!
References:
Peterson W, et al. (2013) Treatment of acute ankle ligament injuries: a systematic review. Achives of Orthopaedic and Trauma Surgery. 133 (8): 1129-1141.
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