Ankle Sprains

The ankle sprain is the most common of all sports injuries. It is rare to find a person who has not suffered even a mild sprain. Whether stepping off a curb, skiing down a hill or playing basketball, ankle injuries occur often.

Studies show ankle injuries are to blame for 25% of lost time in jumping and running sports. In volleyball or basketball, for instance, the ankle sprain accounts for up to 80% of all injuries.

Usually the athlete sprains an ankle by having the foot twist underneath them. The foot will invert, or twist followed by acute pain and swelling. Swelling may be quite sudden and severe. Individuals may hear a pop or snapping in the ankle. Usually the damage to the ankle is torn ligaments, which are there to provide stability to the ankle. In some cases, muscles may be torn as well.

The first step is to control the pain and swelling. This is accomplished by:

1. Icing the ankle 20 minutes every 1 1/2 to two hours. Ideally a compression wrap works best as it usually has a protective material to prevent risk of frostbite. As a short-term option, a bag of frozen peas is commonly used.
2. Compression. This is the most important way to control swelling. Using an elastic wrap, or a compression ice wrap. Always elevate the ankle as much as possible.
3. Rest is important to allow the acute phase to pass. This typically is 1 - 2 days of non-weight bearing using rest at home, crutches or a cane.
4. See your doctor, who may prescribe medication to control the pain and swelling. Physicians will also assess the need for x-rays.

The easiest way to remember is RICE. (Rest, Ice, Compression, Elevation) Never use heat in the first 72 hours.

Rarely is the ankle totally immobilized, such as by putting it in a cast. I usually recommend a brace, which will protect the injured ligaments but will still allow safe, controlled motion in the ankle. It is important to find a brace that has a heel lock strap and supporting stays. Elastic wraps or neoprene slip on sleeves are only recommended to control swelling, not provide support.

Early active aggressive functional rehabilitation is essential to a patients full and speedy recovery. The most important part of the recovery process is therapy. Treatment should begin 2 or 3 days after injury. Initially, the athletic therapist will reduce the pain and swelling in the ankle while helping the athlete get back their full range of motion. Treatment will usually include modalities that accelerate the healing process such as ultrasound and interferential current. As the injury heals and becomes more tolerant to of weight bearing and functional activity, strength exercises will be added with specific exercises. Proprioceptive exercises and functional exercises will quickly follow. Patients with ankle sprains tend to lose what we call proprioception, or balance. Nerves to the ankle get confused after an injury, preventing the muscles from holding the ankle from rolling over. Specific balance exercises are crucial in getting the ankle back to full function and studies show significantly reduces the chance of re-injury.

The goal is to get the athlete or injured worker back to their activity quickly and to prevent further injury to the ankle. The length of time the individual is out will depend on the severity of the sprain, but with good rehabilitation and a brace, that time will certainly be lessened.

Bracing is often considered as an adjunct to active treatment particularly for athletic people or workers with active jobs. A brace will give good lateral support to re-inforce the weakened structure and help prevent further injury. It is recommended that braces be worn for up to 6 months after an injury. Braces should never be substituted for rehabilitation but work in conjunction with redevelopment of strength, stability and proprioception preventing the ankle from becoming chronic.

Athletic therapists and sports medicine clinics can be found in your area by searching www.athletictherapy.org. A certified athletic therapist or sport physiotherapist have the most experience treating soft tissue injuries.