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Oops, I’ve hurt my ankle and I’m not sure what to do!

What is an Ankle Sprain?

Acute ankle sprains are the most commonly occurring lower limb injury seen in individuals who participate in sports or recreational activities.  Up to 70% of the population suffer from an ankle sprain at least once during their life time.

The acute phase of ankle sprain is defined as the first 2 weeks from injury. Patients usually present with signs and symptoms of pain, swelling, stiffness and weakness. There is often bruising around the outside of the ankle, extending to the heel and even the mid-foot. Correct management of the sprains is essential in the early stages in order to prevents these ankle injuries from progressing to a chronic unstable ankle. Good management and rehabilitation is needed to minimise the risk of early development of post traumatic ankle arthritis.

Anatomy:

The anatomy of the ankle and foot is complex with the foot containing twenty-six individual bones and thirty-three joints when you add in the long bones of the lower leg. The primary lateral (outside) stabilising ligaments of the ankle include the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneal fibula ligament (CFL) and lateral talocalcaneal ligament (LTCL). The anterior talofibular ligament is the most commonly Injured of these ligaments.

Risk of ankle sprains in sports?

Acute ankle sprains have been associated with high contact sports that involve running, cutting and jumping. These sports include basketball, soccer, hockey, rugby and volleyball. Lateral sprains (outside of the ankle) are the most commonly seen in sports. It has been shown that individuals with a history of lateral ankle sprains have a 3.5 times greater risk of obtaining further injury. Decreased ankle dorsiflexion (upward movement of the foot) can cause imbalances in the body of the kinetic chain. This can cause poor load transfer through the hip and knee joints which can expose the athlete to further knee injury.

How to manage your sprained ankle!

Early management and rehabilitation can reduce ongoing symptoms such as swelling, stiffness and a chronically unstable ankle as well as prevent further injury. POLICE is a useful acronym to help guide you on how to best manage your sprained ankle. This is particularly crucial in the first 72Hrs of injury.

Protect-Compression in the form of bandaging, bracing, or of a moon put can be applied for 10 days to 6weeks depending on the severity of injury.

Non-steroidal anti-inflammatory drugs will improve pain and swelling in the early stages of healing. NSAIDs are not recommended in the first 48hours after injury as they can slow healing.

Offload- Use crutches if it is painful to walk on it without a limp.

Loading- Gradual loading is necessary to improve the strength and flexibility of the injured ligament. Early rehabilitation that includes strengthening, stretching and balance training is necessary in the early stages of healing. Patients who have had early rehabilitation return safely and sooner to their recreational activities than those who have not.

ICE- Make use of ice to improve pain and swelling. Ice in the form ice packs, cold compression and ice sprays for 20-30 minutes every hour-2hours for the first week of injury will improve pain and swelling. Check the area periodically to avoid frostbite injury.

Compression- Apply compression using a firm bandage.

Elevation- Elevate your injured ankle above the level of the heart.

Here are examples of simple exercises you can do with your physiotherapist

  • References

Anandacoomarasamy A, Barnsley L 2004. Long term outcomes of inversion ankle injuries. Br J Sports Med: 39.

Bell-Jenje. T, Olivier. B, Wood. W, Rogers. S, Green. A, Mckinon. W. 2015. The association between loss of ankle dorsiflexion range of movement and hip adduction and internal rotation during a step down test. Manual Therapy 21 (2016) 256-261.

Carter D, Amblum-Almer J 2015. Analgesia for people with ankle sprains. Art and science. Volume 23|number 1.

Delahunt E, Bleakly C.M, Bossard D.S, Caulfield B.M, Doherty C, Fourchet F, Fong D.T, Hertel T, Hiller C.E, Kaminski T.W, Mckoen P.O, Refshauge K.M, Remus A, Verhagen E, Vicenzino B.T, Wikstrom E.A, Gribble P.A 2018. Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the international ankle consortium. Br J Sports Med 52: 1304-1310.

Green T, Wilson G, Martin D, Fallon K 2019. What is the quality of clinical practice guidelines for acute lateral ankle ligament sprains in adults? A systematic review. BMC musculo-skeletal disorders 20 (394).

Kaminski T.W, Hertel. J, Amendola. N, Dorcherty C.L, Dolan M.G, Hopkins J.T, Nussbaum. E, Poppy. W, Richie. D 2013. National athletic trainers’ association position statement: conservative management and prevention of ankle sprains in athletes.

Mackenzie. M, Zachary. Y, Stephen. W, Erik. A 2019. Epidemiology of ankle sprains and chronic ankle instability. Journal od Athletic Training 54 (6): 603-610.

Courtesy of Groovi Movements and Groovi PhysioSoftware.

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