The ankle is the most commonly injured joint in the body. A sprain occurs when the ankle is twisted in a sideways motion resulting in injury to the ligaments and soft tissues that restrain the joint.
How Do Ankles Sprain?
The most common type of ankle sprain is when the foot and ankle are rolled inward stressing all the ligaments on the outside of the ankle. 90% of ankle sprains occur in this way.
Landing and jumping sports like netball and basketball have a high incidence of ankle sprain. High heel shoes also increase the risk of sprain.
The degree of symptoms tends to correlate with the degree of injury.
Ankle sprains are classified into 3 grades.
Grade 1 sprains involve a mild stretch of the ligament which usually resolves within 2-7 days.
Grade 2 sprains are moderate injuries involving a partial tear of the ligament. The ankle is moderately swollen and very painful.
Grade 3 sprains are severe and involve a complete rupture of the ligament. They are significantly swollen but may not be that painful. The ankle will often feel unstable.
First Aid Measures
RICE – Rest, Ice, Compression and Elevation is still the treatment of choice in the early stages of any acute ankle sprain.
RICE controls the swelling, eases the pain and prevents further tissue damage.
Should I Seek Treatment?
If the ankle swells considerably and it is difficult to walk it would be advisable to seek assessment from your GP or Physiotherapist.
It is important to ascertain the grade of injury to determine the management required. They will carry out a physical examination to assess this structural damage. An important part of this examination is testing the integrity of 2 main stability ligaments.
Management of a grade 3 ankle sprain is critical. The damaged ligament must be immobilized to some extent (ankle stability brace) to allow the healing process to repair the ligament.
Poorly managed grade 3 sprains often result in a lifetime of instability.
Rehabilitation of grade 2 & 3 ankle sprains involves restoration of proprioception (balance reactions), muscle strength and normal ankle range.
Do I Need a Brace or Strapping?
Elastic braces may be beneficial for controlling swelling and giving balance feedback. This type of brace does not restrict ankle motion and will not prevent a sprain.
Ankle strapping restricts joint motion and is used in the acute stage to protect healing ligaments as well as in the early stages of returning to sport.
Rigid braces generally stop the ankle from twisting sideways and are used for unstable ankles in the acute stage to promote healing and in chronic unstable ankles to prevent injury while playing sport or walking on rough ground.
Mike Stewart is a Manipulative Physiotherapist at the Oamaru Physiotherapy Clinic. He has post graduate qualifications in Manipulative Therapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist.
He has toured as a Physiotherapist with the Maori All Blacks from 1996 to 2008.
Source: Oamaru Physiotherapy Clinic written by Mike Stewart and Michelle Sintmaartensdyk