Chris our sports therapist here at Back2Balance talks about Ankle Sprains and ways in which to manage them.
Ankle sprains are a highly common injury in both sporting and non-sporting populations. Approx. 2 million cases of ankle sprains are reported a year, with 73% of those being a lateral ligament sprain. Ankle sprains are also reported to make up 7-10% of all admissions to A&E. This blog will discuss what ankle sprains are and ways in which to treat them.
The ankle joint consists of your tibia (shine bone) and your talus (a bone at your ankle). The talus sits just under the tibia in which it articulates with. Due to the formation and positioning of these bones the greatest movements are being able to bring your toes up towards your shin (dorsiflexion) and being able to paint your toes (plantarflexion). These movements are key in walking and running and just about any function when being on your feet. Therefore, it is important this joint has extra support, hence the need for 3 main ligaments of the outside aspect of your ankle known as your lateral ligaments. As well as 3 main ligaments on the inside aspect of your ankle known as your deltoid ligaments. (Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. 2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability.
There are still rotational movements at the joint, despite its main function being in the singular plain. Ligaments are needed to provide structural stability to the joint to help prevent any large rotational forces causing an opening up type effect of the ankle joint.
Pink – Anterior talofibular ligament
Green – Calcaneofibular ligament
Purple – Posterior Talofibular ligament
Ligaments are strong fibrous structures made up of collagen. Their main function is to keep to two different bones together and to not allow to excess movement at a joint. However, if put a ligament under a large stretch type stress they can become torn and even rupture. So, thinking back to the ankle and the positioning of the lateral ligaments and if you were to roll your ankle either walking on an unstable surface slipping and stumbling on icy ground. Even playing sports, cutting and turning sports where you are at greater risk of ‘rolling’ your ankle. Any one of these can cause a stretch on those outer ankle ligaments and putting them at risk of becoming torn and getting injured.
If you have sprained ankle you may experience the following:
- Loss of function
- Loss of balance and confidence in the ankle
- Loss of movement
- Inability to fully weight bear
Within the first 24-48 hours it is important to manage the initial symptoms such as swelling and bruising. As this is when your body’s inflammation will be at its highest. Studies have even shown the earlier you start treatment of symptoms the quicker your return to full function will be. The best way to do this is through following the POLICE procedure.
POLICE stands for Protection, Optimal Load, Ice, Compression and Elevation
- Protection is making sure no further damage can be caused to the area. For example, having the ankle in a splint or strapping.
- Optimal Load means the amount of body weight you are putting through the ankle. This will depend on the severity of the injury, therefore use pain as a guidance on how much you are able to tolerate. If weight bearing is causing pain greater 4 out of 10 then look to reduce the amount of weight through the joint. Crutches and ankle boot are best to reduce load.
- Ice is applying for 20 minutes at a time causing vasoconstriction of the blood vessels and slows down the inflammation process.
- Compression helps to reduce swelling of the area which helps to keep the ankle moving freely without restriction.
- Elevation is believed to prevent as much blood flow to the area and prevent the area from swelling excessively.
(Herrick, Karlee, and Volberding 2021)
Once the initial swelling and inflammation has gone down rehab exercises can be started straight away. These exercises will vary from person to person as each case may present differently. However, the fundamentals will always stay the same. The first stage is to significantly reduce and swelling and bruising through gaining early motor control and following the POLICE procedure. As well as start to gain daily function such as weight bearing and walking. This often done through the use of TheraBand and self-limiting exercises.
The next stage would be to gain strength back into the ankle and gain balance back. To try and prevent any muscular wastage. Resisted movements a long with weight bearing exercises are most commonly used, as well as the ability to perform gym based tasks such as lunges.
The final stage is getting you back to your previous state of fitness. This will again change depending on the individual and their own personal demands. For example, this stage would focus on being able to return to running comfortably without pain or swelling. Therefore, exercises would be focusing on being able to withstand the forces of running, jumping, and hopping first. Rehab should be a nice progressive journey that you learn a lot about your body and injury (Chin et al. 2017)
If you have any questions about any of the point raised or are in need of any rehab exercises, please do not hesitate to get in contact with us!
Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of athletic training, 54(6), 603-610.
Herrick, J., Karlee, A., & Volberding, J. (2021, February). Effectiveness of Early Therapeutic Exercise Versus Rest, Ice, Compression, and Elevation in Treatment of Acute Lateral Ankle Sprains: A Critically Appraised Topic. In Oklahoma State University Center for Health Sciences Research Days 2021: Poster presentation.
ee Chin, L. C., Basah, S. N., Affandi, M., Shah, M. N., Yaacob, S., Juan, Y. E., & Din, M. Y. (2017). Home-based ankle rehabilitation system: Literature review and evaluation. Jurnal Teknologi, 79(6).