|
A sprained ankle occurs when there is a sudden sideways or twisting movement of the foot. An ankle sprain can occur during playing sport such as jumping or running on to an uneven surface, or during everyday activities such as stepping off a curb or slipping on ice. Sprained ankles are common injuries.
What happens inside the ankle when it is sprained? An ankle sprain is an injury to the ligament in the ankle. The ligaments control excessive movement of the joint. With an ankle sprain, the ligament is stretched too far, and is either partially or completely torn. There are two broad categories of ankle sprain:
What are the symptoms of an ankle sprain? Pain with swelling and bruising are the common symptoms associated with an ankle sprain. The degree of symptoms tends to correlate well with the extent of the damage to these ligaments.
The bruising will move down the foot towards the toes in the days after the ankle sprain--as gravity pulls the blood down into the foot. |
|
What can be done about it?
The early treatment of a simple ankle sprain is the "RICE" method of treatment:
More severe ankle sprain injuries, including complete tears of the ligaments and fractures of the bone may need different treatment. It is important that you see your doctor or therapist, osteopath or physiotherapist before beginning treatment or if your symptoms do not steadily improve.
Manual therapy
It is always best if you seek the advice of a qualified therapist such as an osteopath or a physio as although a period of immobilisation is needed initially, too much rest and immobilisation can cause stiffness and slow up rehabilitation, as the scar tissue shortens and causes a reduced range of movement, painful and more prone to further injury. Gentle massage and mobilisation 72 hours after the initial injury can be helpful. Your therapist may also give you ultrasound or other treatments. You will be advised about aspects such as:
Considering a semi rigid ankle support whilst going about your normal activities until symptoms have gone, allowing support whilst also allowing the ankle to move. A programme of exercises which may help.
These may take the form of:
1) Range of Motion Exercises
Some simple exercises can help maintain ankle motion, and stretch the injured ligaments in the ankle joint.
2) Strengthening Exercises
The next step in recovery from ankle sprains is strengthening the muscles that surround the ankle joint. By strengthening these muscles, help prevent further injury by increasing the ankle support. Some exercises to perform after an ankle sprain include:
3) Proprioceptive training
Proprioception is your body’s ability to give feedback to the brain. This can be damaged after an ankle sprain, leading to problems controlling ankle movements. Good proprioception helps you to make immediate, unconscious minor adjustments to the way you walk when walking over uneven ground. This helps to prevent you overstretching ligaments and causing further sprains. The best way to simulate proprioceptive retraining is with wobble board or wobble cushion.
4) Activity-Specific Training
Activity specific exercises may include simply walking or jogging, or may be more intense for athletes who participate in football, or other sports. The key is to progress slowly. Begin at very low intensity, and very low duration of activity, and slowly work up - never suddenly increase either the intensity or duration of your activity.
Here is a sample progression for a soccer player
Once these activities can be done at full speed with no pain, patients can resume their sport. More sport specific exercises can be given to you by a coach or trainer if needed.
Badly ruptured (torn) ligaments or muscles
These sometimes require surgery. Your doctor will assess if this is necessary (but it is not needed in most cases).
Medication control
You may not need any medication if the sprain is mild and you can tolerate the pain. If needed, painkiller options include the following:
Please read our disclaimer.
The early treatment of a simple ankle sprain is the "RICE" method of treatment:
- Rest: For the first 24-48 hours after the injury. This is a critical treatment period and activities need to be reduced. Gradually put as much weight on the ankle as tolerated and stop using a crutch / stick when you can walk normally ie (with minimal to no pain or limp).
- Ice: For the first 48 hours after the injury, ice pack and elevate the ankle sprain 20 minutes at a time every 3-4 hours. The ice pack can be a bag of frozen vegetables (peas or sweetcorn, ice cubes or buy and ice pack. Only use for 20 minutes at a time, any longer may damage the tissues.
- Compression: Using a tubular bandage,such as a’ tubigrip’ wrap the ankle from the toes all the way up to the top of the calf muscle. The wrap should be snug, but not cutting off circulation to the foot and ankle. So, if your foot becomes cold, blue, or falls asleep, re-wrap! And keep the foot elevated.
- Elevate: Keep your ankle sprain higher than your heart as often as possible. Elevate at night by placing books under the foot of your mattresses--just stand up slowly in the morning. This helps the fluid drain back into the centre of the body.
More severe ankle sprain injuries, including complete tears of the ligaments and fractures of the bone may need different treatment. It is important that you see your doctor or therapist, osteopath or physiotherapist before beginning treatment or if your symptoms do not steadily improve.
Manual therapy
It is always best if you seek the advice of a qualified therapist such as an osteopath or a physio as although a period of immobilisation is needed initially, too much rest and immobilisation can cause stiffness and slow up rehabilitation, as the scar tissue shortens and causes a reduced range of movement, painful and more prone to further injury. Gentle massage and mobilisation 72 hours after the initial injury can be helpful. Your therapist may also give you ultrasound or other treatments. You will be advised about aspects such as:
Considering a semi rigid ankle support whilst going about your normal activities until symptoms have gone, allowing support whilst also allowing the ankle to move. A programme of exercises which may help.
These may take the form of:
1) Range of Motion Exercises
Some simple exercises can help maintain ankle motion, and stretch the injured ligaments in the ankle joint.
- Achilles stretches: In a seated or lying down position, take a towel and loop it around your toes. Pull the ends of the towel, pulling your toes upwards, and feel the stretch in the back of the ankle. Perform this 3-4 times a day for several minutes.
- Alphabet writing: While seated or lying down, write the alphabet in the air with your toes. Make the letters as big as possible. Get creative by trying all uppercase, then lower case, then cursive, etc...
2) Strengthening Exercises
The next step in recovery from ankle sprains is strengthening the muscles that surround the ankle joint. By strengthening these muscles, help prevent further injury by increasing the ankle support. Some exercises to perform after an ankle sprain include:
- Toe raises: Stand on a stair or ledge with your heel over the edge. Stand up on your tip toes, then in a controlled manner, let the heel rest down. Repeat 10-20 times (each foot), 4 times a day.
- Heel and Toe Walking: Walk on your toes for one minute, then on your heels for one minute. Alternate walking on your heel and toes, and work up in time to a total of 10 minutes, repeating 4 times each day.
3) Proprioceptive training
Proprioception is your body’s ability to give feedback to the brain. This can be damaged after an ankle sprain, leading to problems controlling ankle movements. Good proprioception helps you to make immediate, unconscious minor adjustments to the way you walk when walking over uneven ground. This helps to prevent you overstretching ligaments and causing further sprains. The best way to simulate proprioceptive retraining is with wobble board or wobble cushion.
4) Activity-Specific Training
Activity specific exercises may include simply walking or jogging, or may be more intense for athletes who participate in football, or other sports. The key is to progress slowly. Begin at very low intensity, and very low duration of activity, and slowly work up - never suddenly increase either the intensity or duration of your activity.
Here is a sample progression for a soccer player
- Jogging: Begin at 50% intensity. Jog 100 yards, walk 100 yards. Repeat 4 times. Increase intensity and duration over 2-3 weeks
- Figure of Eights:Jog in a figure-of-8 pattern around cones. Begin with the cones near each other. Each day, spread out the cones and increase the speed.
Once these activities can be done at full speed with no pain, patients can resume their sport. More sport specific exercises can be given to you by a coach or trainer if needed.
Badly ruptured (torn) ligaments or muscles
These sometimes require surgery. Your doctor will assess if this is necessary (but it is not needed in most cases).
Medication control
You may not need any medication if the sprain is mild and you can tolerate the pain. If needed, painkiller options include the following:
- Paracetamol is useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then.
- Anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are recommended for the first 48 after the injury only. They relieve pain and may also limit inflammation and swelling, however it is also thought that after 48 hours they may prevent healing. Some NSAIDS require a prescription, and they do have side effects.
- Rub-on (topical) anti-inflammatory painkillers containing ibuprofen at pharmacies without a prescription. There is debate as to how effective rub-on anti-inflammatory painkillers are compared to tablets. Some studies suggest that they may be as good as tablets for treating sprains. Some studies suggest they may not be as good. However, the amount of the drug that gets into the bloodstream is much less than with tablets, and there is less risk of side-effects.
Please read our disclaimer.