Managing Lateral Ankle Sprains.
A high majority of people will report a traumatic injury of the ankle at some point in their lifetime, most of which are a result of sport. 75% of injuries at the ankle occur on the lateral (outside) aspect and so, this article will focus on the management of these particular injuries. In the Netherlands, approximately 520,000 people annually report a traumatic injury of the ankle of which 200,000 are a result of sport. Only half of the injuries receive medical attention and 40% develop chronic ankle instability (CAI). Of the people who play sport, 60-90% resume the same level of sporting performance 12 weeks after the injury.
The ankle can become weak and unstable after trauma, preventing any activity or sport. The right management is essential to ensure return to sport safely with reduced risk of reinjury. Despite the growing body of evidence, international debate shows controversy for best treatment strategies after ankle injuries. A recent clinical guideline published by the British Journal of Sports Medicine on ‘The Management of the Acute Ankle’ will be the foundation of this article.
Ankle sprains are most commonly caused by inversion of the ankle (the foot turning in). This accompanied with our body weight and speed is more than enough to tear or rupture the ligaments on the outside of the foot. The Anterior TaloFibular ligament is the usual suspect – it is estimated 90% of sprains involve this ligament. With tearing or trauma comes immediate swelling and pain. Both are a good guide for how severe the injury is.
The general management guidelines are:
- Rule serious injury out
- Respect the healing process
- Manage pain and swelling
- Restore range of movement, control and strength
It is estimated only 15% of ankle injuries result in fracture however, it is essential to rule any serious bone injury out. ‘Ottawa Rules’ is a clinical tool used to decipher whether further investigation (such as X-ray) is necessary or not. In simple terms, if there is pain along any of the bones that are susceptible to injury (the fibia, tibia, base of fifth metatarsal or navicular) accompanied with being unable to walk four steps – a scan should be considered. If you can walk again in 48 hours post injury it is evidence of good prognosis.
Most serious injuries of the ankle will be accompanied by inflammation and considerable swelling within the first 3 – 24hours. Providing the best healing environment for the injured tissue is essential. Ligaments can take up to 12 weeks to heal and it is important not to overload or stress the area during this period to prevent re-injury. Avoid activities that involve twisting, fast turning or heavy resistance. Walking for long periods can be enough to cause excessive pain or discomfort.
The well known RICE has been updated to POLICE which stands for Protect, Optimal Loading, Ice, Compression and Elevation. These principals aim to manage pain and swelling as best possible in the early stages.
Pain medication and anti-inflammatory drugs are sometimes used at this point to allow early movement and reduce pain. There is debate over the pros and cons of these and you should always consult your GP or Pharmacist before taking them.
Protection of excessive movement in the early stages can be achieved with strapping or a moon boot/brace. For the first 3-5 days only – depending on severity of injury.
The level of activity the patient would like to return to will determine the level of rehabilitation required. The ankle can become quite stiff and weak after injury with control and balance reduced. The joint has to be stable and strong in order to withstand 1.5 times our body weight when walking and up to 8 times our body weight when running.
Rehabilitation will often start with range of motion exercises, strengthening of the ankle muscles and some balance work. This is gradually progressed to end stage jumping, landing and cutting drills before return to pitch or court activities. Ankle injuries that are poorly rehabbed often fall into the 40% chronic ankle instability category and repeatedly reinjure causing more issues down the line.
So, make it a priority to get your ankle checked by a medical professional to rule out any bone/serious injury and guide rehab. Timescales for recovery vary depending on severity of soft tissue damage acquired.
If you to have your ankle sprain seen to, feel free to contact us or book online to see one of our chartered physiotherapists.
