Management of ankle sprains

18th Mar, 2024

Key Points

  1. Understanding Ankle Sprains: Ankle sprains are common injuries where ligaments are stretched or torn, often during sports or physical activities.
  2. Role of Physiotherapy: Early and guided physiotherapy is essential for recovery and preventing recurrent ankle sprains.
  3. Rehabilitation Guidelines: Treatment includes protection, optimal loading, manual therapy, and therapeutic exercises.
  4. Prevention Strategies: Preventive measures such as balance training, proper footwear, and ankle bracing can reduce the risk of sprains.
  5. Return to Sport: Specific criteria must be met before returning to sports, including pain-free movement, full range of motion, and adequate strength.

Understanding ankle sprains and their management

What is an ankle sprain?

An ankle sprain is an injury that occurs when the ligaments, which are the tough bands of tissue that support the ankle bones, are stretched or torn. This injury often happens when the ankle is twisted, turned, or rolled beyond its normal range of motion. The severity of an ankle sprain can range from mild to severe, depending on the extent of ligament damage. Symptoms typically include pain, swelling, bruising, and difficulty walking.

Why are ankle ligaments important?

Ankle ligaments are crucial for the stability and function of the ankle joint. They connect bones to other bones, providing structural support and limiting excessive movements. Key ligaments include:

  1. Lateral ligaments: These are most commonly injured and include the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. They prevent excessive inversion (turning in) of the foot.
  2. Medial ligaments: The deltoid ligament is a strong, broad ligament on the inner side of the ankle, preventing excessive eversion (turning out) of the foot.

These ligaments help maintain balance and control movements, playing a vital role in everyday activities and athletic performance.

What are the risks of recurrent ankle sprains?

Recurrent ankle sprains can lead to chronic ankle instability, where the ankle feels unstable or frequently gives way. This condition can result in long-term issues such as:

  1. Chronic pain and swelling: Persistent discomfort and inflammation in the ankle.
  2. Reduced mobility and function: Difficulty performing daily activities and sports.
  3. Arthritis: Increased risk of developing osteoarthritis in the ankle joint due to repeated injuries and joint wear and tear.
  4. Decreased quality of life: Ongoing instability can limit physical activities and impact overall well-being.

Who is at risk of an ankle sprain?

Anyone can suffer from an ankle sprain, but certain factors increase the risk:

  1. Sports participation: Athletes in sports that involve jumping, running, or sudden changes in direction (e.g., basketball, football, soccer) are more prone to sprains.
  2. Previous sprains: A history of ankle sprains increases the likelihood of future injuries.
  3. Improper footwear: Wearing shoes that do not provide adequate support can contribute to ankle sprains.
  4. Environmental hazards: Uneven surfaces, slippery floors, and obstacles can lead to accidental twists and falls.
  5. Muscle weakness and poor balance: Insufficient strength and stability in the muscles supporting the ankle can increase injury risk.

Why do we need physiotherapy after an ankle sprain?

Physiotherapy is essential for effective recovery and prevention of future sprains. Key benefits include:

  1. Pain and swelling reduction: Techniques such as manual therapy and compression can alleviate pain and swelling.
  2. Restoration of mobility and strength: Exercises and stretches help regain ankle flexibility and strength.
  3. Improved balance and proprioception: Training on balance boards or stability exercises enhances proprioception, reducing the risk of future sprains.
  4. Guided rehabilitation: A physiotherapist designs a personalised program to ensure proper healing and prevent complications.

What are the recommended treatment guidelines for an ankle sprain?

The treatment of ankle sprains typically follows these guidelines:

1. Initial care (first 48-72 hours):

  •    Protection: Avoid activities that cause pain or discomfort.
  •    Compression: Use an elastic bandage to reduce swelling.
  •    Elevation: Keep the ankle elevated above heart level to minimise swelling.

2. Rehabilitation phase:

  • Weight-bearing: Gradually start bearing weight on the injured ankle as tolerated.
  • Exercises: Focus on range-of-motion, stretching, and strengthening exercises to restore function. Balance training is crucial to improve proprioception and prevent further injuries.
  • Manual therapy: Techniques like joint mobilisation and soft tissue massage can aid recovery and improve mobility.

3. Advanced rehabilitation:

  • Functional training: Incorporate sport-specific exercises to prepare for return to activities.
  • Bracing and taping: Use ankle braces or tape during high-risk activities to provide additional support.

4. Long-term management:

  • Continued exercises: Maintain a routine of strengthening and balance exercises to prevent future sprains.
  • Education: Learn about proper footwear, safe exercise practices, and ways to avoid environmental hazards.

What are some ways we can prevent an ankle sprain?

Preventing ankle sprains involves a combination of lifestyle adjustments and specific strategies:

  1. Regular exercise: Strengthen the muscles around the ankle and improve balance through exercises such as calf raises, ankle circles, and balance board training.
  2. Proper footwear: Wear shoes that provide good support and fit well.
  3. Warm-up and cool-down: Always warm up before physical activity and cool down afterward to prepare the muscles and ligaments for exercise.
  4. Use of ankle supports: During high-risk activities, wear ankle braces or tape for additional support.
  5. Avoid risky environments: Be cautious on uneven surfaces, wet floors, and other hazardous areas.

How do I know I can return to sport after an ankle sprain?

Returning to sports after an ankle sprain should be based on specific criteria to ensure full recovery and prevent re-injury. Key indicators include:

  1. Pain-free movement: You should be able to move the ankle without pain.
  2. Full range of motion: The injured ankle should have the same range of motion as the uninjured ankle.
  3. Strength: The strength of the injured ankle should be comparable to the uninjured one.
  4. Balance and proprioception: You should be able to perform balance and proprioception exercises without difficulty.
  5. Functional testing: Pass functional tests such as hopping, jumping, and running without pain or instability.

Conclusion

Ankle sprains are common injuries that can lead to chronic instability if not properly managed. Understanding the importance of the ankle ligaments, the risks of recurrent sprains, and the benefits of early and guided physiotherapy is crucial for effective recovery and prevention. Adhering to recommended treatment guidelines, taking preventive measures, and ensuring readiness before returning to sports can help maintain ankle health and prevent future injuries. Contact us today to find out more!

Ref:

American Academy of Orthopaedic Surgeons. (2021). Ankle sprains: What updated guidelines mean for you. Journal of Orthopaedic & Sports Physical Therapy, 51(4), 161-162. doi:10.2519/jospt.2021.0504

Rhon, D. I., Fraser, J. J., Sorensen, J., Greenlee, T. A., Jain, T., & Cook, C. E. (2021). Delayed rehabilitation is associated with recurrence and higher medical care use after ankle sprain injuries in the United States Military Health System. Journal of Orthopaedic & Sports Physical Therapy, 51(12), 619-627. doi:10.2519/jospt.2021.10730

Martin, R. L., Davenport, T. E., Fraser, J. J., et al. (2021). Ankle stability and movement coordination impairments: Lateral ankle ligament sprains revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51, CPG1-CPG80. doi:10.2519/jospt.2021.0302

Smith, C. A., & Jones, T. R. (2021). Physical therapy after an ankle sprain: Using the evidence to guide physical therapist practice. Journal of Orthopaedic & Sports Physical Therapy, 51(4), 159-160. doi:10.2519/jospt.2021.050

Frequently Asked Questions

Can I walk on a sprained ankle?

Walking on a sprained ankle is possible, but it should be done cautiously. Resting the ankle initially and using crutches if necessary is recommended to avoid further injury.

How long should I ice my sprained ankle?

Current guidelines do not universally recommend icing for sprains. Consult a physiotherapist for personalised advice on managing swelling and pain.

Is it normal for a sprained ankle to still be swollen after a week?

Yes, swelling can persist for several weeks after a sprained ankle. Continue to follow your treatment plan, including rest, compression, and elevation.

What exercises can help strengthen my ankle after a sprain?

Exercises like calf raises, ankle circles, and balance training on a wobble board can help strengthen your ankle and improve balance after a sprain.

When can I start running after a sprained ankle?

You can start running after a sprained ankle once you have regained full pain-free range of motion, strength, and stability in the injured ankle. Consult with your physiotherapist for a tailored return-to-sport plan.

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