Jan 21

Ankle Sprains- A common life and sports injury

Ankle Sprains- A common life and sports injury

Sometimes you are caught off guard and you lose your balance landing on your ankle. The pain quickly disappears and you think nothing of it. An ankle sprain can be more severe; your ankle might swell and hurt too much to bear weight. If it’s a severe sprain, you might have felt a “pop” when the injury occurred.

Over the years, there has been an increase in yearly organized athletic programs with over 80 percent males and females participating under the age of 18 every year. Sports injuries including ankle sprains have increased with a total of 25,000 sprains a day. Seven in 1,000 Americans will have an ankle sprain. Ankle sprains are 40 percent of all ankle injuries and 45 percent of basketball players have ankle sprains with soccer and football players not far behind in the statistics. A third to two thirds of sprains will have continued problems.

What is a Sprained Ankle?

A sprained ankle is when one or more of your ligaments on the outer side of your ankle are stretched or torn. If a sprain is not treated correctly, you can have long-term ankle problems. Usually the ankle is rolled either inward (inversion sprain) or outward (eversion sprain). Inversion sprains, the most common type, cause pain along the outer side of the ankle. Pain along the inner side of the ankle can be a more serious injury to the tendons or ligaments that support the arch and should always be looked at by a doctor.

An ankle sprain can be difficult to distinguish from a broken bone and an X-ray may be needed. If you are unable to put weight on you ankle or if there is significant swelling or deformity, you should seek medical treatment. Explain to your doctor what you were doing when you sprained your ankle. He or she will examine it and may order an X-ray to make sure you did not break any bones. Most ankle sprains do not require surgery, and minor sprains are best treated with a functional rehabilitation program. Depending on how many ligaments are injured, your sprain will be classified as Grade I, II or III.

Ankle Sprain Classification
Grade 1- Mild
Grade 2-Medium
Grade 3- Severe

Ankle Sprain Management

Most ankle sprains do not need surgery. The key is to control the swelling right away and most swelling usually goes down with a few days. Treating your sprained ankle correctly may prevent chronic pain and instability.

For a Grade I ankle sprain, follow the R.I.C.E. guidelines:
• Rest your ankle by not walking on it. Limit weight bearing.
• Ice it to keep down the swelling. For the first 48 to 72 hours or until swelling goes down, apply an ice pack for 10 to 20 minutes every 1 to 2 hours during the day.
• Compression can help control swelling as well as immobilize and support your injury. An elastic compression wrap will help decrease swelling and should be worn for the first 24 to 36 hours. Don’t apply the wrap too tightly. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage.
• Elevate the foot by reclining and propping it up above the level of the heart as needed.

For a Grade II ankle sprain, follow the R.I.C.E. guidelines and allow more time for healing. Your doctor may immobilize or splint your sprained ankle.

A Grade III ankle sprain puts you at risk for permanent ankle instability. Rarely, surgery may be required to repair the damage, especially in competitive athletes. For severe ankle sprains, your orthopedic surgeon may also consider treating you with a short leg cast for two to three weeks or a walking boot. People who sprain their ankle repeatedly may also need surgical repair to tighten ankle ligaments.

If you are not taking any prescription pain relievers, you may want to take an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling. Be safe with medicines. Read and follow all instructions on the label.

When can you return to life and sports?

Ankle sprains take an average of 2-6 weeks to heal but can take can up to 4 months, depending on the severity. Depending upon the type of sports you play will also play a factor to when you can return to the game. Ankle support such as an ankle brace, air stirrup, or hiking boots maybe recommended by your orthopedic doctor to be worn during the healing time to protect the ligaments. After the ankle is healed, wearing an ankle brace or taping the ankle may help prevent reinjury.

Ankle Sprain Healing Goals:
• Pain free
• Full strength
• Full range of motion

Once you can stand on your ankle again, your orthopedic doctor or physical therapist will give you exercise routines to strengthen your muscles and ligaments and increase your flexibility, balance and coordination. The timing and type of rehabilitation exercises may vary according to your doctor or physical therapist.

You will probably do the following types of exercise:

• Range-of-motion exercises to move the joint as far as you can in every direction.
• Stretching exercises to keep your Achilles tendon (heel cord) flexible while your ankle heals.
• Strengthening exercises to strengthen the muscles to help support your ankle.
• Balance and control exercises to help your foot and ankle respond to activities, which can help prevent reinjury. You can usually start balance and control exercises when you are able to stand without pain. Your doctor or physical therapist will let you know when you can start these exercises. You should not feel pain while doing these exercises.

Prevention

To prevent future sprained ankles, listen to your body’s warning signs to slow down when you feel pain or are tired, and stay in shape with good muscle balance, flexibility and strength.

Keeping the ankle in good strength is critical to avoid reinjury and you may use:
• Dynamic stabilizers
• Taping (looses 50% strength in first 20 minutes)
• Bracing

You should continue stretching exercises daily and especially before and after physical activities to prevent reinjury. Even after your ankle feels better, continue with muscle-strengthening exercises plus balance and control exercises several times a week to keep ankle strength. Some people who have repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

A common question patients ask us: Is taping or bracing better?
We advocate bracing because you can easily adjust it throughout the game without medical/trainer help. Taping performed by a trainer/doctor is effective. If you do not have a professional tape your ankle, it will be ineffective.

Almost all ankle sprains heal on their own with proper home treatment and rehabilitation exercises. Surgery to repair torn ligaments is usually only considered when there is a severe ligament tear (or tears) or if the ankle remains unstable after rehab. Surgery is also considered if you have broken a bone.