What is it?
An ankle sprain typically refers to an injury to the ligaments on the outside of the ankle. The ankle rolls outwards which places stress on the ligaments resulting in stretching and tearing. The ligaments on the outside of the foot are referred to the lateral ligament complex and are made up of 3 ligaments. The most commonly injured ligament is the anterior talofibular ligament but sometimes two or all three ligaments are injured. Bleeding; with inflammation and pain is the common outcome.
How did I get it?
The usual mechanism is rolling the ankle outwards. By doing this the ligaments that hold the ankle together are put under stress which results in them being stretched and torn. Watch the accompanying video to see a typical mechanism of this injury.
How is a diagnosis made?
A diagnosis is made on the history of the injury and examination of findings. An x-ray may be needed to discount a broken bone as this is commonly associated with a high grade ankle sprain.
What are the symptoms?
Pain, swelling and bruising to the outside of the ankle are common. The degree of swelling and bruising can be extensive as the soft tissues that are frequently torn have a good blood supply. There may be significant pain and difficulty bearing weight through the ankle.
What should I do?
If you rolled or rotated your ankle outwards (rather than inwards) and you can walk on the ankle without too much pain, then it is better to continue walking on it. This will actually aid recovery. There is now reliable evidence that the early activity rather than strict rest is preferable and that complete rest can slow recovery. You should however, stay within the realms of comfort and avoid activities that cause significant discomfort.
Ice, compression and elevation are also very useful. They work
to decrease the amount of inflammation and swelling. Whilst some inflammation and swelling is important, there is often so much that it blocks beneficial nutrient-rich blood from entering the area. Ice, compression and elevation decrease blood flow initially, while acting to increase blood flow in the medium and long term to facilitate healing. Ice is very useful initially and helps decrease the amount of swelling. 10 minutes on, 10 minutes off and 10 minutes on again every 2 hours is effective and decreases the likelihood of nerve damage from ice burn.
Compression and elevation assist to decrease the amount of swelling.
While most ankle sprains heal very well in the short term there is a definite increase in re-injury after an initial ankle sprain. This increased risk of injury is actually very high and there is a 300% chance of re-injury. This means that you are now three times more likely to sprain your ankle in the future. To decrease this risk it is important to engage in rehabilitation exercise and consider learning to tape your ankle or invest in an ankle brace.
What does rehab involve?
Rehab can be divided into 4 phases and each phase will have a separate hand out and video tutorial.
Phase 1 involves reducing pain and increasing function to the point where walking without a limp is possible.
Phase 2 involves increasing walking and starting some strength, flexibility and balance training to teach the muscle to work again and if needed make up for any loss of ligament stability.
Phase 3 involves starting some jogging and progressing that to running with slow change of direction and running curves. It also involves some specific work with landing mechanics.
Phase 4 involves high speed running and change of direction with jumping and finally return to play.