WHAT IS AN ANKLE SPRAIN?

WHAT IS AN ANKLE SPRAIN?

An ankle sprain is a stretch or tear in one or more of the lateral (outside) ligaments of the ankle. Ankle ligaments are slightly elastic bands of tissue that keep the ankle bones in place. Because the ankle is responsible for both weight-bearing and mobility, it is particularly susceptible to injury. The relatively small joint has to withstand large forces exerted when walking, running and jumping, especially if the surface is uneven. Most ankle sprains happen when the ankle twists or rolls suddenly, usually a rapid and uncontrolled movement. The most common injuries happen when the foot rolls onto the outside of the ankle, straining the outside ligaments of the ankle joint.

Symptoms of a sprained ankle include; pain, tenderness and swelling, bruising, trouble moving the ankle, and sometimes an inability to put your full weight on the ankle.

HOW LONG DOES IT TAKE TO HEAL?

Most people recover completely from mild sprains within two to six weeks. More severe sprains can take up to six months before you can return to full activity, or sport. Once a significant sprain occurs, without good rehabilitation the joint may never be as strong as it was before the injury. It is not surprising therefore that many people have a history of repeated ankle sprains. With the correct rehabilitation however, you can help your ankle become even stronger than it was before the injury.

WHAT CAN BE DONE?

Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to inflammation, part of the natural healing process. However, the body tends to overreact to sudden traumatic injury and as a result excess inflammatory fluid accumulates which can result in ‘scar’ tissue production. Too much scar tissue may prevent normal function with reduced flexibility and increased risk of re-injury. It is important to get medical advice to gain a positive diagnosis and

ADVICE HANDOUT

Follow the PRICE guidelines immediately after injury and for at least 3 days afterwards before doing anything else.

Your local physio therapist as well as most massage therapists can assist you with this:

PROTECT – Protect the injured tissue from undue stress and avoid ALL movements in the same direction as when the injury occurred.

 REST – Unload the joint (take the weight off it) as much as you can in the first 72 hours after injury. Try and avoid walking on the joint as much as possible.

ICE – Ice is an amazing natural healer and a great short-term pain reducer. It is also believed to have a beneficial effect in reducing swelling and promoting healing. The optimal amount of time to apply ice is around 10-15 minutes in bony areas such as the ankle. It can be applied as often as desired to achieve pain relief, ideally every 1-2 hours.

COMPRESSION – This is advised for the first 72 hours, but only while your foot isn’t elevated. The compression can be firm if it doesn’t cause pins and needles or any loss of feeling around the joint.

ELEVATION – Reduces the flow of blood to the area which helps reduce swelling. Elevation is recommended in the first 72 hours after injury. However, remove any compression while your foot is elevated unless you are wearing just a light compression bandage.

When following PRICE it is also important to avoid HARM, hence the saying: ‘Give PRICE and avoid HARM’.

HARM is an acronym for Heat, Alcohol, Running, Massage.

Following this acute management phase, your physical therapist will start some ‘hands-on’ treatment to mobilise and strengthen the joint. This phase of treatment is crucial to ensure you return to full function and prevent future injury. Adequate preparation for activity is key and weight-bearing should progress gently. Drastic changes in activity level and performing unpractised skills expose your ankle to re-injury. Gradually build up your fitness level. Your ankle, and the rest of your body, will thank you for it!

WHY IMMEDIATE TREATMENT IS IMPORTANT

The success of injury healing can be boosted by appropriate, effective and timely action particularly in the early stages of an injury (ie. the first 72 hours).

Any ‘soft-tissue’ is subject to injury including ligaments (which join bones to bones), tendons (which join muscles to bones) and to muscles themselves. The immediate reaction of the body to injury is similar irrespective of the soft tissue structure and is known as an inflammatory reaction.

Injuries can be caused by overstretching, bruising or crushing. A strain describes overstretching of a muscle, while a sprain describes overstretching of a ligament or tendon.

THE INFLAMMATORY REACTION

Tissue injury usually involves damage to small blood vessels that results in bleeding at the site of injury. This bleeding leads to the four main signs of inflammation:

1. Heat – chemicals released from the damaged tissue causes dilation of surrounding blood vessels to bring healing agents to the area. The result is more blood and therefore heat
2. Redness – is due to the increase in blood to the area
3. Pain – is caused by the chemicals released from the injured tissues as well as the increased tissue pressure from the fluid acting on nearby nerve endings
4.  Swelling – is the result of this accumulation of extra fluid.

This inflammatory reaction is necessary as it is part of the natural healing process. However the body tends to overreact to sudden traumatic injury and as a result more inflammatory fluid accumulates than is necessary for healing. This fluid contains a protein that turns into replacement ‘scar’ tissue. If too much can form it may prevent the structure returning to normal function with reduced flexibility and increased risk of re-injury.