What causes an ankle sprain?
Ankle sprains usually occur when there is a rapid, internal or external force, which forces the ankle to roll outwards or inwards, causing the ligaments to stretch and tear. This leads to swelling, pain & restriction of movement. Common scenarios include; landing on an opponent’s foot or miss-placing your foot on an uneven surface.
Symptoms include pain, swelling, bruising and a resultant loss of normal range of motion that commonly affects your normal movement patterns. It is important to fully rehabilitate ankle sprains as a lasting range of motion limitation can result in increased forces on the hip and knee. Ligaments can take up to 12 weeks to heal, due to poor blood supply.
Ankle sprains generally occur from an injury where ligaments which support the ankle are damaged/torn
- This leads to swelling, pain and restriction of movement
- Once the ligament has been damaged, it is necessary to 1) allow time to heal, and 2) rehabilitate correctly to ensure return to normal function
- Ligaments can take up to 12 weeks to heal, due to poor blood supply
- The ligaments of the ankle are grouped into two categories: the Lateral Collateral Ligaments and the Medial Collateral Ligaments
Hints for self-management
- Initial management should follow the RICER principles R: Rest I: Ice wrapped in a towel (20mins every 2 hours for the first 48 hours post-injury) C: Compression E: Elevation R: Review with a health professional
- If there is excessive pain or pain that persists for more than a few days, this may indicate a more serious injury such as a fracture or a high ankle sprain; both which require medical attention immediately
- Injury to the lateral or outside ligaments of the ankle is more common than to the medial ligaments, as these are not as well supported by the bony structures of the ankle
- Damaging ligaments will affect your ability to balance
- Swelling can often persist in the ankle due to gravity
- Many sports, including Netball, require athletes to tape their ankles before playing a game to help prevent the extremely high rate of injury
- An x-ray can be taken to rule out a fracture
- Conservative treatment such as support and strengthening exercises will be very effective in most ankle sprains
- If a fracture or high ankle sprain is present, immobilisation +/- surgery may be required to allow healing
Symptoms/ What to look out for
- Difficulty walking
- Restriction of range of movement
When should you seek medical advice for ankle pain?
There can be several reasons for ankle pain so it is important to establish the true cause of this as early as possible.
If you have sustained trauma to the joint (e.g falling downstairs), and there is marked swelling, instability and pain on weight bearing, then certainly seek medical attention as there may be a fracture or ligament tear.
If your pain happens spontaneously and persists through the night, or worsens with activity, this may also indicate medical or health professional assessment.
In instances of ongoing, unprovoked chronic pain where there is a restriction to the range of motion and function, there is also reason to consult a medical professional.
How to prevent ankle sprains:
- Ensure that specific training has been undertaken prior to any competitive events
- That there has been a gradual increase in training load/volume/intensity
- That training involving balance, flexibility and strength is included on a regular basis
- Agility training incorporating change of direction and speed is also necessary
- Appropriate recovery and rest is allowed between sessions/competitions
- Ankle taping/bracing for protection from previous injuries is occurring
- Wear appropriate stable footwear designed for the specific activity
- Warm up all lower limb musculature prior to the activity
- Avoid activities that cause pain – if the pain does occur, cease the activity and commence RICER
Below is a series of useful preventative exercises designed to build the strength of the tendons that support your ankle and improve your ankle stability.
A final option is to tape your ankle before you play sports (see my ankle taping video for instructions on how to tape). This will give you more support when you’re returning to tennis after ankle sprain, or if you suffer from repeated ankle sprains.
- Current evidence suggests that a combination of paracetamol and an NSAID (anti-inflammatory) may offer superior pain relief compared with either drug alone
- Recent evidence suggests that controlled movement, together with ice and mobilization by your skilled physiotherapist can result in an earlier return to normal movement and function
- Bracing or taping has been shown to assist in the prevention of recurrent ankle sprains. Neither bracing nor taping seems to be the better option, despite personal preferences for one or the other.