The ankle joint is one of the most common sites for acute musculoskeletal injuries and sprains account for 75% of ankle injuries. Most ankle sprains (80%) are caused by “rolling” your foot inward (inversion sprain). Without adequate care, acute ankle trauma can result in chronic joint instability. Spraining an ankle can increase your risk of re-injury by as much as 40-70%. But proper post-injury care, rehabilitation exercises and bracing can help decrease your risk of future injury.
High impact activities that require jumping, running, cutting, and/or twisting will inevitably produce a higher rate of ankle sprains. Ankle sprains range in severity from grade I to grade III. Grade I is a partial tearing of a ligament. Grade II is an incomplete tear of a ligament with moderate functional impairment and grade III is a complete tear and loss of integrity of a ligament. The most common ligaments that are injured during an inversion sprain are on the lateral (outside) portion of the ankle. They include the anterior talofibular, the calconealfibular, and the posterior talofibular ligaments. Most ankle sprains will heal with conservative treatment with only those sprains that involve a grade III or chronic instability needing surgical intervention.
To speed up recovery after an acute ankle sprain you should immediately begin using P-R-I-C-E. Protection – your ankle may be splinted, taped, or braced to prevent further injury. Rest – some period of partial to nonweight bearing with possible use of crutches may initially be needed to avoid limping and pain with walking. Ice – use of ice for the first 24-48 hours at 15-20 minute increments every 2-3 hours will help control swelling and decrease pain. Compression – wrap an elastic bandage from toes up to midcalf using even pressure and wearing until swelling decreases. Elevate – make sure the ankle is above the level of your heart.
Prolonged immobilization of ankle sprains is a common error. Functional stresses to the ankle help it heal stronger and faster. Functional rehabilitation begins on day one and continues until pain-free walking and other weight bearing activities are possible. The four components of rehabilitation include range of motion (ROM), progressive strengthening, proprioceptive or balance training, and sport-specific activities. Initial pain-free ROM should start immediately in all directions with a progression to gentle calf stretching with your knee straight and bent. Use of resistive bands for progressive strengthening can be added as pain and ROM allow. As you achieve full weight-bearing without pain, balance training exercises will help further rehabilitate the body’s “awareness” of where the ankle joint is in space. Lastly, slowly working back into your normal sport/recreational activities should allow a full return to pain-free function.
The use of an ankle brace can help support the joint when internal stability has been lost. They should not, however, be used to replace your strengthening and balance exercises but instead be an adjunct to your body’s dynamic support. If you have given your body a good environment to heal and you continue to experience pain and dysfunction past 2 months, you should probably pay a visit to a physician or physical therapist if you have not already. You may also choose to see one of these health care professionals sooner to rule out more serious pathology. At Therapeutic Associates we would love to help you return to your maximum function after your ankle injury. We do take appointments without a doctor’s referral.