Ankle sprains are one of the most common sporting injuries, however can also be frequently seen in other populations (such as women who wear high heels!). A sprain is defined as the tearing of the ligaments connecting bone to bone and help stabilize the joint where they are located. Ankle sprains are commonly seen in sports involving jumping, turning and twisting movements (eg basketball, football, netball) and explosive changes of direction (eg soccer, tennis and hockey).
The ankle is a hinge joint formed between the bones of the lower leg, the tibia and fibula, and the talus (a bone in the foot). This joint allows the foot to bend upwards (dorsiflexion) or downwards (plantarflexion) and allows small amounts of rotation. Two bones of the foot, the talus and the calcaneus (heel) form the subtalar joint which allows side to side movement of the foot.
Both the bones and the ligaments provide some stability, with the ligaments mainly limiting side to side movement. These ligaments are located on the inside and outside of the ankle.
The most frequently sprained ligaments are those stabilizing the outside of the ankle (lateral ligaments). These account for 80% of ankle sprains.
Lateral Ligaments of the Ankle
The most commonly injured ligament is the anterior talofibular. In more severe injuries, the other ligaments may be involved and there may be dislocation and fracture. Some ligaments sprains may also involve the ligament between the tibia and fibula. These sprains may involve a fracture, take longer to heal and sometimes require surgery.
Why might I have sprained my ankle?
Some of the proven risk factors for ankle sprains include:
- Previous or existing ankle injury especially if poorly rehabilitated (biggest risk factor!)
- Lack of strength and stability around the ankle joint or in the joint itself
- Poor balance
- Sudden change in direction
- Increasing age
What should I do first?
The initial management of any soft tissue injury consists of the RICER protocol – Rest, Ice, Compression, elevation and Referral to an appropriate health or medical practitioner. Paracetemol can be taken if pain relief is needed however anti-inflammatory drugs should not be taken in the first 2-3 days after injury as they may increase risk of injury and impair healing.
RICE protocol should be followed for 48-72 hours in order to reduce bleeding and damage in the ankle joint. The ankle should be rested and placed in an elevated position with an ice pack applied for 20 minutes every two hours (do not apply ice directly to the skin). An appropriate size compression bandage should be used to limit bleeding and swelling in the ankle joint.
The No HARM protocol should also be followed – no Heat, no Alcohol, no Running or activity and no Massage. This will limit bleeding and swelling in the joint.
A sports medicine professional (such as one of the Osteopaths at OGOSH) should be seen as soon as possible after the injury to determine the extent of injury and to provide advice on treatment and rehabilitation. If we believe further investigation is required we may order an Xray or other testing to determine the extent of the injury before commencing any treatment. In the case of more severe sprains, we may recommend crutches or immobilization for a short period of time in a cam boot.
How soon can I have hands-on treatment?
This depends entirely upon the severity of the sprain. In most minor ankle sprains, gentle hands on treatment can commence within 3 days, as well as gentle mobility exercises. In more severe ankle sprains, it may be necessary to obtain imaging first to rule out a fracture.
When can I return to play? (or dancing in my high heels?)
Most ankle sprains will health within 2-6 weeks, however more severe sprains may take 12 weeks. Ankle sprains can be graded 1-3 in severity.
As a general rule, Grade 1 sprains will take 2 weeks to heal, Grade 2 will take up to 6 weeks and Grade 3 will take 12 weeks, but this depends also on whether there has been bony damage or surgery has been performed.
Your Osteopath can provide you with a comprehensive rehabilitation program to reduce the chance of re-injury. This will include flexibility, balance, stretching, strengthening and sport-specific exercise. We will also often brace or tape the ankle to provide support until full function returns. More severe ankle sprains may require bracing or taping for up to 6-12 months post-injury while playing sport.
Take home points
- You should ALWAYS see a sports medicine professional (physiotherapist, osteopath or sports doctor) after an ankle sprain
- You should ALWAYS complete a comprehensive rehabilitation program!
Too many times I have seen poorly managed and recurrent injuries due to patients not seeking professional advice or not completing a rehabilitation program.
We are here to help you to be healthy, happy and pain-free and to keep doing the things you enjoy!
Click here to book an appointment with Catherine or call the clinic on 5255 5040 (OG) or 4202 0446 (L) to discuss how Catherine can help you achieve your health goals.