For every active person there is always going to be the risk of spraining your ankle, whether it comes from a heavy tackle in football or a misplaced footstep when running. It is usually followed by immediate pain and that knowledge that you aren’t going to be able to carry on.
What should you do if it happens, how do you rehabilitate it and how can you prevent it from happening again?
Have I sprained my ankle or is it more serious?
This piece will focus on lateral ankle sprains as they are the more common injury. This is where you roll over on the outside of your ankle.
Lateral ankle sprains are very painful and I often hear people say they must have broken their ankle. Although this is usually unlikely (it estimated 15% of x-rays of sprained ankles show a fracture), serious injury does need to be ruled out.
Swelling is very common and so is pain on walking immediately after injury, often there is some accompanying bruising. The “Ottawa Ankle Rules” are used as a guideline for determining fracture, the general rules is if you have pain on pressure around the lateral malleoli (bony prominence at the side of the ankle) or at the base of the 5th metatarsal (bony prominence midway along the side of the foot) combined with the inability to walk 4 steps, then an x-ray is recommended to rule out fracture.
(Bachman, L.M. et al. (2003) Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. British Medical Journal, 2003;326:417)
In severe injuries the swelling is usually fairly rapid, within the first few hours. If you are able to walk 48hrs later and the swelling is reduced it is often a good sign that it was a minor sprain.
Ankle Sprain Treatment
If it is an ankle sprain what do you need to do to help it recover?
There will always be an element of time involved and the body needs time to heal. The old saying of RICE – rest, ice, compression, elevation is important to help improve pain and swelling.
An ankle sprain can be graded from grade 1 – grade 3 and depending on the severity will depend on the healing process. In an ankle sprain it is the ligaments that become damaged; they can be stretched, torn or rupture completely. Ligaments can take around 12 weeks to heal but without the proper rehab people can still have complications months and even years later.
After 3-4 weeks usually the ankle will start to feel a lot more comfortable, however the new collagen will still be fragile and trying to do too much can result in a re-injury. It is good to try to keep the ankle moving as it will stiffen up very quickly if it is not being moved around.
Ankle Sprain Rehabilitation
The most important part is developing the strength back in the ankle. If the ankle hasn’t been used the muscle strength will decrease and the proprioception in the ankle will reduce. There is a high reoccurrence rate with lateral ankle injuries and poor rehab is often the factor in this.
You should start doing simple exercises such as moving the foot up and down and side to side as soon as is comfortable. As time progresses, add some resistance to the exercises; therabands are a good way of doing this.
As the ankle improves, more challenging exercises such as wobble cushions/ balance boards and dynamic exercises like lunges and squatting should be included to help increase ankle movement and balance.
Sport specific exercises should be the final thing to add. Starting with light running before adding speed and turning.
As with everything you should never try to do too much too soon, a medical professional will be able to put a plan in place for you.
Depending on the injury treatments such as taping, ankle mobilisation, acupuncture or foot orthoses may also be useful in the rehab and prevention of the injury.