What is an Ankle Sprain?
A sprain refers to the injury to tissues that join the muscle to a bone (ligament), caused by overstretching. The ligaments in the ankle joint provide support to the adjoining bone structure as well as stability to the joint by restricting side-to-side movement, and can be injured during regular activities. Ankle sprain usually occurs following sudden, awkward movement of the foot due to slippage or uneven ground. The severity of an ankle sprain depends on the number and extent of ligament involvement. Injury to the ligaments could be a stretch injury or a tear injury (partial or complete). Some of the most important ligaments present in the ankle include: deltoid, calcaneofibular and anterior and posterior talofibular ligaments. Injuries to these ligaments can affect the ankle function to a significant extent.
Ankle sprains constitute about eighty-five percent of ankle injuries. Although people usually recover from ankle sprains quickly, an increased risk for future injury is often associated with failure to appropriately rehabilitate these joints. Pain and swelling are often associated with ankle sprains.
Sprains can be classified in general as first, second and third-degree based on the severity of the tear (minimal, moderate, and complete respectively). Second and third degree sprains often causes more diffuse pain and swelling in ankle. Proper care must be given when attempting to turn the injured ankle joint.
Types of ankle sprain
There are two types of ankle sprain.
About 85-90% of ankle sprains are categorized as inversion injuries. This type of sprains occurs when the foot is abruptly turned inward (inversion). The ligaments on the outer side of the ankle joint (right side of the right leg or left side of the left leg) are stretched too far in this type of sprain. Instability of the ankle joint leading to collapse occurs frequently with severe 2nd- and 3rd-degree ankle sprains. Pain is noted only on the outer side of the ankle joint with minimal or no pain on the inner side.
Eversion injury is the other kind of ankle sprain which occurs when the foot is abruptly twisted outwards (eversion). The ligaments on the inner side of the ankle (left side of the right leg or right side of the left leg) are stretched out too far in this type of ankle sprain. Accordingly, the pain is felt on the inner side of the affected ankle.
How is ankle sprain treated?
Treatment procedures should be initiated at the acute phase (1-3 days of injury) itself to minimize swelling and to allow the mobility of the ankle joint. General measures used to treat ankle sprain are collectively referred to as PRICES (protection, relative rest, ice, compression, elevation, and support). It includes the following steps:
- Protection to the ankle is provided by the use of air splints or plastic and Velcro braces and can be used for 4-21 days. These supports can be discontinued when swelling and pain at the site of injury have decreased.
- Relative rest is advocated at the early phase but, early, pain-free movements and exercises can be performed.
- Ice: Application of ice for 15-20 min thrice daily can be used to control swelling, pain, and muscle spasm.
- Compression: Swelling can be minimized by the use of compression with a wrap, an ankle sleeve, or by using ankle support.
- Elevation: Swelling can also be decreased by elevating the injured ankle while lying down or sitting.
- Support: Taping or the use of lace-up ankle supports can provide ankle support
Rehabilitation therapy should be started at the earliest to hasten healing and increase the range of movement of the ankle joint. Medications such as painkillers and anti inflammatory agents can be used for control of pain and swelling.
Rehabilitation for ankle sprain
Following general treatment for pain and swelling with medications other general measures, physiotherapy can be tried for minimizing the damage. Proper rehabilitation therapy is highly essential for early recovery from the injury, return to normal function and also to improve the function of the ankle joint. Affected individuals with moderate to severe ankle sprain can benefit from physiotherapy. It is particularly helpful in those with chronic problems of the ankle joint and recurring symptoms. Physiotherapy modalities such as cryotherapy (cold therapy using ice packs), and electric muscle stimulation could be used following an acute injury, to reduce pain and swelling.
Intensive physiotherapy are advised in those who have regained some function in their joint and are able to tolerate further therapy. Appropriate exercises will bring back the original full range of motion (ROM), strength, and stability of the ankle joint. The physiotherapist may also advise some home based exercise program to expedite the rehabilitation process and to enable the affected individual to return to his/her previous level of activity. For mild and moderate injuries, immediate, protected walking is encouraged, and physiotherapy for mild sprains is focused on the return of ROM, strength, endurance, and balance (proprioception).
These exercises when performed can help preserve ankle motion, and also help in stretching the ligaments which were injured during the sprain in the ankle joint.
Range of Motion exercises
- Towel /Achilles stretch: This stretch exercise can be initiated soon after an ankle sprain and can be done three to four times a day for several minutes. This exercise can be performed in lying down position or in sitting pose.
- Alphabet writing: Writing alphabets with the use of toes can be done as a simple start up exercise to improve the range of motion.
These exercises help in muscle strengthening the ankle joint and are the next step in recovery from sprained ankle. Further injury can be prevented by increasing the muscle strength that supports the ankle joint.
Physical therapy exercises that can be initiated after an ankle sprain include: toe raises and, heel and toe walking in which either standing up or walking on toes helps strengthen the joint.
Balance and proprioceptive training for ankle sprain
The proprioception or the balance of the ankle joint can be damaged after a sprain leading to future problems which take a toll on ankle movements. To initiate balance and proprioceptive retraining, wobble board exercise as well as those indicated in the range of motion and strength sections can be effective.
Plyometrics and Sports Specific Exercises
Sports specific/activity specific exercises can be done once the ankle has recovered from the injury. Walking, intense athletic exercise, jogging can be started at this point
- Range of Motion: the first priority in the phase of the rehabilitation process is regaining a full range of motion of the ankle joint.
- Stretch and Strengthen: Introducing strength back to the injured muscles, ligaments and tendons by motion exercise is the next step.
- Balance and Proprioception: Balancing drills and exercise would be the next step and often repeat injuries occur because of overlooking this step.
- Plyometrics and Sports Specific Exercises: This is last part of the rehabilitation process and will aim to return the ankle to a pre-injury state. Dynamic exercises are incorporated in this step to strengthen your ankle and make it stronger to the pre injury levels.