Ankle sprains are a common athletic injury that has a propensity for high reoccurrence. Did you know approximately one-third of all athletic injuries occur at the ankle? Ankle sprains have one of the highest reoccurrence rates of all injuries at up to 73% in athletic individuals. These numbers may be even higher as only about 50% of those who suffer an ankle sprain seek medical care. Understanding the basics of ankle sprains can give you the tools you need to help prevent it from happening and heal successfully.
What is it?
An ankle sprain is a generalized term that refers to a pull of a ligament around the ankle joint. This is most often the anterior talarfibular ligament on the outside of the ankle which occurs due to rolling the foot in (“inversion”). It is also possible to strain the ligaments on the inside of the ankle as well as multiple other ligaments surrounding this complicated joint. Severity of sprains can vary greatly. With severe injury this action of rolling your foot may also strain muscles, traction nerves or even cause an avulsion fracture. Signs and symptoms following a sprain can including swelling, bruising, pain to touch, limited weight bearing tolerance, decreased ankle range of motion as well as lack of strength and balance.
What are the risk factors?
Knowing the risk factors contributing to an ankle sprain can help decrease the risk of occurrence as well as for re-injury. These risk factors include having a previous sprain, not participating in a proper warm up before a sporting event, not wearing proper external support (such as an ankle brace), having decreased ankle range of motion (do your stretches!) and not participating in balance training.
What to do after?
Immediately after a sprain follow the acronym P.R.I.C.E.M.
P: Protect. This is key to preventing aggravation of structures and symptoms while your ankle is in a vulnerable state. Depending on the severity, this may mean anything from using crutches in order to decrease weight bearing, using a walking boot or wearing an over the counter brace.
R: Rest. It is important to let tissues rest for your body to go through the natural healing process. Rest may mean a complete unloading of the joint, limiting your walking or taking a couple weeks off your usual exercise/sport.
I: Ice. Typically icing 15-20 minutes (until the area is numb) for a minimum 3 times per day is recommended. Ice is important in the acute stage to decrease pain by decreasing neuron conduction velocity (slows the nerve signal) and for decreasing inflammation/swelling through vasoconstriction. Stay away from heat during this stage as it will do the opposite of these goals.
E: Elevate. Elevation of your foot helps the swelling drain. The key to this is your foot must be above your heart level, therefore you must be lying down with your foot propped up. You can do this while resting as well as when icing.
C: Compression. A light ace wrap for compression can help decrease inflammation accumulation.
M: Medication. Non-sterioidal anti-inflammatories (NSAIDS) are typically recommended in order to decrease the inflammation as quickly as possible. It is important to discuss this with your doctor before taking medications to ensure safety. NSAIDS are not meant to be taken for prolonged periods as they do have systemic side effects.
Setting up an appointment with your Doctor or Physical Therapist is recommended. These professionals will evaluate the ankle to identify and rule out other pathology. If symptoms are severe enough, your doctor may also prescribe imaging (such as an x-ray or MRI) to help with this assessment.
Although you will likely be feeling much better after a couple weeks with doing P.R.I.C.E.M., stability deficits can continue for over a year and place you at a much greater risk of re-injury and chronic issues. A Physical Therapist can develop an individualized exercise program to progress balance, strength, and range of motion. They will then help with transition to functional sport-related tasks in the later stages of rehab to ensure you are ready to return to your prior activity level. Manual therapy may be done to help decrease the inflammation during acute stages, improve joint glide and resolve soft tissue restrictions. A Physical Therapist may also apply modalities, fit a brace, apply tape and/or give prevention education.
A simple “rolled ankle” may have larger implications and cause symptoms lasting longer than you may think. Don’t be a statistic. Understanding risk factors, doing P.R.I.S.M, and seeking professional help will assist with successful recovery and re-occurrence prevention.