Ankle sprains can occur at any point during the sporting season, but often when we have had a break over the closed season, the muscles may not have been exercised and may be a bit weaker.
Most ankle sprains are inversion injuries, like the one below. An inversion injury causes a sprain of the lateral ligaments on the outside of the ankle, the most commonly injured ligament being the anterior talo-fibular ligament. This is a football player who went over on his ankle at his first training session before the start of the season. Rehabilitation is essential to get the best possible recovery, to get back to your sport as soon as possible and to prevent recurrence of the injury.
So how does the injury occur?
Ankle sprains usually happen when there is a rapid shift of body weight over the landing or weight-bearing foot causing the ankle to roll outwards, whilst the foot turns inward causing the lateral ligament to stretch and tear.
What are the symptoms of an inversion injury?
Depending on the severity of the sprain, it may;
- Be difficult to bear weight on the foot and you may need to use crutches for a short period of time
- Pain on the outside of the ankle when moving the foot, particularly if pushing the toes in a downwards direction or turning the foot inwards
- Swelling and bruising can occur on either side of the ankle
How long does it take to get better?
That depends on the severity of the sprain.
A mild ankle sprain (Grade 1) injury takes up to 3 weeks whereas a severe sprain can take up to 3 months.
What is the treatment?
For a mild sprain, minimal intervention only may be needed. It is important to restore full ankle movement, strength and balance to return quickly to sport but also to prevent a recurrence of the sprain. It has been cited that the recurrence rate of first time lateral ligament sprains is 70% (Clinical Biomechanics. 2009 Jun 30;24(5):451-8.)
For a severe ankle sprain, following the initial first aid PRICE programme to reduce pain and swelling, physiotherapy treatment is required to restore full function to get you back to your sport as quickly as possible.
For the first 3 days, the PRICE programme includes
Protection: Protect the ankle from further injury by resting the foot (which may involve using crutches) and avoiding activities that may cause further injury
Resting: Resting for the first 24 – 48 hours after injury. This means avoiding sport, taping the ankle if needed, and possibly reducing the amount of walking you do, using of crutches if needed,
Ice: Apply a cold pack (10 – 15 minutes, three times per day)
Compression: Apply compression bandage / tubigrip to control swelling caused by the ankle sprain
Elevation: If the ankle is very swollen, when sitting, try to elevate the foot above the level of the heart is a great way to reduce swelling. Avoid sitting with the foot down or standing still as this will increase swelling
During the first 3 three days, it is important to move the foot within pain free limits. This helps to improve the circulation.
After the first week, it is important to see your physiotherapist. Treatment will help to restore movement, improve walking, increase strength and dynamic stability of the ankle, improve balance and co-ordination. Gradually function will be restored so you will get back to activities such as running.
Towards the end of the rehab programme, it is vital to improve the ability for the ankle to bear load and improve the skills needed during activities of daily living as well as work and sports.
What is chronic ankle instability?
Following an ankle sprain, particularly a more severe one, there can be on-going problems of instability in the ankle. This is usually caused by not regaining full muscle strength, loss of postural control, impaired balance and co-ordination. A rehabilitation programme is required to prevent or reduce the possibility of ankle instability.