Sprained Ankle: Treatment Strategies
There are many ways to sprain your ankle. Injuries occur in both sporting and non sporting environments. In this article Paul Carter, Specialist Physiotherapist at Physio2go St. Albans, discusses common causes of this injury and effective treatment strategies. In his clinical work, Paul sees injuries caused in a variety of sporting arenas, including football, hockey, tennis and rugby. However, people undertaking what are considered less dangerous activities such as walking, dancing and even getting out of bed are also susceptible to an ankle injury.
What is an ankle sprain?
An ankle sprain occurs when the foot is rolled or forced beyond what is the normal range for the ankle. This can be caused by stepping awkwardly on uneven ground, jumping for a ball and landing, rolling the ankle or slipping off a kerb.
The most common type of ankle sprain occurs when the ligaments of the outside of the ankle are over-stretched, this is called an inversion injury. Less common is an injury to the inside of the ankle, called an eversion injury. Ligaments are strong structures which hold bones together and form joints. Ankle sprains will not only cause damage to the ligaments but can also damage other soft tissue structures such as tendons and muscles. These can also get over-stretched or torn during injury.
How bad is it?
Ligament sprains are graded by degree of severity:
• Grade 1 – Described as a stretching / minor tear of the ligament. Normally this causes some degree of pain and swelling. Normal daily activity will not be affected but the patient will not be able to jog or jump without pain.
• Grade 2 – Described as a severe tearing of the ligament. In most cases there will be increased swelling compared to a grade 1. There is likely to be bruising, this can extend up the lower leg and or down into the foot. Patients will normally find walking painful but are able to take a few steps. They may have to use crutches or sticks to aid mobility.
• Grade 3 – Described as a complete tear of the ligament. There will normally be quite severe pain. Walking is usually difficult, commonly the ankle may feel unstable or can give way. An urgent appointment with a health care professional such as GP, physiotherapist or orthopaedic consultant is recommended for assessment and further management.
What if I get injured?
Having injured your ankle, what should you do? Do you need to see your GP? Do you need an x-ray? Generally, you must decide on the severity of your symptoms to determine the best course of action. Symptoms that may need a medical opinion include:
• Inability to put weight on the foot
• Significant pain above the ankle or in the foot
• Significant swelling (unable to get shoe on due to swelling that does not go down overnight).
• Numbness or pins and needles in the foot or toes
• If the ankle does not improve after a few days
Treatment / Management
The initial treatment of an acute ankle injury follows the P.O.L.I.C.E. guidelines. This involves 6 steps to minimize the effects of injury. The following protocol should be used as soon as injury occurs:
P = Protection – Protect against further damage – take weight off the injury – use crutches or splints if necessary.
O.L = Optimum Load- Injuries need time to heal. The initial 24-48 hours after the injury is critical for treatment and management. As a general rule, put as much weight on the ankle as you feel able. Little and often is the best approach.
I = Ice – Use ice or a cold pack to reduce pain and inflammation. Wrapping ice or very cold products in a cloth will help reduce the risk of an ice burn. It is very important for the first 48 hours after an injury to use the ice on a regular basis. We would normally recommend every 3-4 hours for 10 minutes at a time. Leaving ice on for more than this period can damage the soft tissue.
C = Compression – Compression of the swollen area helps reduce swelling which in turn aids the mobility of the joint. You can use specific elasticated bandage or you can use a normal bandage. Remember to start wrapping from the toes up and bandage to at least two thirds up the calf. Make sure that the foot / toes do not go numb, blue or cold; if this happens you may have the bandaging too tight.
E = Elevation – Elevating the injured area above the heart reduces blood flow to the area; this helps to decrease swelling. Drink enough fluids, at least 1500 mls (3 pints) a day, otherwise dehydration may occur which can lead to disorientation and unsteadiness.
Do I need an ankle support?
In most cases it is unnecessary to wear a specific ankle support. If the ankle is very swollen, an elasticated bandage can help. It is not advisable to buy other types of ankle support / brace without advice from a healthcare professional. Note – in severe cases where you are not sure you should always consult a medical professional.
When will it be better?
Speed of recovery depends on many factors, including age, general health and fitness. A rule of thumb guide to healing times for muscle would be 4-6 weeks depending on the severity of the injury and 8-12 weeks for tendon and ligament, once again depending on the severity of injury.
Generally the younger you are the quicker the healing time. As we age the time it takes to heal can be a third or a half longer than in our younger years. If you have medical problems such as Diabetes, this can also increase the healing time by a third or longer. As a rule, the worse the damage, the longer the healing time. With all injuries it is important to follow a graduated return to normal activity, be it high level sport or just walking the dog.
What if it doesn’t get better
If an ankle injury does not get better, it is important to seek expert advice. At Physio2go we see many patients with both new and old ankle injuries, in some cases months and even years after the injury. In the majority of patients, with appropriate assessment, treatment and a specific exercise regime, these ankle problems resolve and patients are able to return to normal activity levels.
At Physio2go we see many ankle injuries which have a varying degree of severity. A recent patient of ours was a lady of 38 who had stepped off a curb awkwardly and “rolled“ her ankle. At the time of the injury she was unable to walk without limping heavily; the ankle was swollen and very painful. This patient had not seen a GP or been to A&E. She had put ice on the ankle once and had tried not to walk on it.
The lady was seen in clinic 3 days after her injury. Examination revealed decreased movement of the ankle joint, with pain, generalised swelling around the ankle joint which was worse on the outer aspect, redness and slight bruising of the ankle, foot and lower leg. The ligaments of the outside of the ankle were very painful to touch. The diagnosis was a grade 2 ligament sprain, caused by an inversion type injury (slipping off a curb and rolling the ankle). This lady was treated with physiotherapy, which included electrotherapy, manual techniques and a graduated home exercise programme.
Her rehabilitation lasted for 9 weeks. At the end of her treatment she was able to return to her normal activity levels which included jogging.
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