Ankle sprains are the most common injury in athletes, they can separate any athlete from the competition.
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Mechanism of Injury
Lateral Ankle Sprain: Typically, it is caused by inversion with plantarflexion (turning your toes inward and pointing them down), which can lead to injury to the ligaments at the ankle's outside.
Medial Ankle Sprain: Typically from eversion with dorsiflexion (turn your toes out while pointing up), which can lead to injury of the ligaments at the medial side of the ankle. This injury is rare than lateral sprains because the ligament (deltoid ligament) is so strong. It may take double time to recover it compared to lateral sprain. It is also usually associated with fractures of the fibula or further bones in the ankle like medial malleolus, articular surfaces, and talar dome.
Syndesmotic Sprain: Injury at the front or back lower ligaments of the ankle. This often happens from hyperdorsiflexion (pointing the toes up very far), and eversion (pointing the toes out).
Symptoms
Lateral Ankle Sprain
- Due to a rich blood supply, significant potential swelling within 2 hours.
- Tender to touch the outer ankle ligaments, bruising which drain into the feet.
- There are different levels of instability depending on the severity of the sprain.
- Test positive for ligament laxity of your outer ankle ligament.
- No fractures were found on the X-ray.
Medial Ankle Sprain
- Tender to the contact over the interior ankle ligament.
- Swelling and bruising along the medial side of the ankle.
- Positive test for the ligament laxity in the interior of the ankle ligament.
- An x-ray is required to rule out avulsion fracture (a piece of bone taken away from the bone) or fracture of the interior ankle bone or top of the ankle.
Syndesmotic Sprain
- Positive tests for severe swelling (possibly fracture) and further/rear ligament laxity in the lower leg
- Swelling and pain over the further/rear ligaments and the lower leg space.
- A specific X-ray might show abnormal joint space in the lower legs.
- The recovery time for sprains is slower (longer) than other types.
- Required to rule out avulsion and fracture.
There are 3 degrees of ankle sprains that indicate the severity of the sprain that is mentioned below.
First Degree: involves minimal swelling, no limp, no ligament laxity, point tenderness, or difficulty hopping. A typical recovery time for an athlete is between 2-10 days.
Second Degree: There is more swelling in the ankle and increased ligament laxity. The athlete and limp will not be able to lift the heel, hop or run. The average recovery time is between 10 to 30 days.
Third Degree: This includes a lot of tenderness, swelling on both the outside and inside of the ankle, even more ligament laxity, and a reduced ability to place any weight on the ankle. The recovery time can happen anywhere from 30 to 90 days.
On-Site Management
The R.I.C.E Method is recommended for the immediate treatment of ankle injuries. This is to reduce swelling and delay rehabilitation. Avoid activities that stimulate blood flow, like heat rubs, hot showers, and excessive weight-bearing.
R.I.C.E Method
REST It can be tough to cut back on training, but it is essential for recovery. Slowly, you will be able to return to agility and jumping-like activities.
Place ICE at your ankle for 10-20 minutes every 1.5 to 2 hours for the first two to three days. Or until the pain stops.
COMPRESS The area can be trimmed by a trainer or physiotherapist using an ankle wrap and a tensor. This reduces swelling and internal bleeding.
ELEVATION is essential to encourage blood flow to your heart for healing.
Rehabilitation & Medical Referral
When the ankle is the second or third degree or a syndesmotic sprain, it is necessary to avoid fracture that you take medical aid. To reduce swelling and pain, a physician might prescribe anti-inflammatory medication. It is essential to consult the physician once after confirming the sprain. This will allow you to treat the injury properly and come back in the play. The therapist will determine the appropriate treatment plan based on a specific injury. This may include biomechanics, changes to footwear, posture, bracing options, and return to play protocols.
A therapist might use laser and ultrasound treatment to reduce swelling and pain. Another treatment is friction massage, which promotes healing and decreases scar tissue formation. The therapist will also work to restore the full ROM (range of motion) at the ankle, strengthen surrounding muscles & regain proprioception. The therapist will also prescribe a complete ankle rehabilitation program to prevent future ankle sprains and strengthen the ankle joint.
Come Back In Activities
This is a slow process & time is affected by many factors, involving the severity of the injury, how long it has been since symptoms begin, history of injuries to the region, and compliance to cure. Following is a list of guidelines to follow the activity.
- Work towards a complete ROM (range of motion) in the affected ankle compared to the unaffected ankle.
- Work towards a complete power of the affected ankle compared to the unaffected ankle.
- Work directly in the direction of jogging without pain or lameness, go ahead for knitting and cutting laterally, besides hope and jump on the affected ankle.
General tests are used by your doctor to monitor your play.
Lateral Hop Test: Stand on the uninjured leg and make three continuous hops in the outside direction. Then, you will stand on the injured leg and continue to hop in the same direction as before.
Modified Rhomberg Test (Single leg stance): With your arms crossed over the chest, you can balance the uninjured leg while standing. You can then stand on the injured leg and balance on it to compare.
The Heel Rocker Test: Lean back against a wall, pull your toes off the ground, and rock backward on your heels. To exhaustion, raise your toes until they are completely off the ground.
Ankle Joint Dorsiflexion: Your therapist will use a measuring device to measure your range of motion while keeping your knee bent and straight.
Test For Joint Laxity: A manual Anterior drawer test ankle will be applied to the injured and non-injured ankle.
Stair Run: Your therapist will watch you run down the stairs without you holding onto the handrail.
The following may be useful for competitive athletes:
- You can run straight ahead with no pain or limping.
- You can cut 45-degrees, at first half-speed, then at full speed. You can make 20-yard figures of eight, first at half-speed, then at full speed.
- You can cut 90-degree, at first half-speed, then at full speed.
- You can run 10-yard figures of eight at half speed, then at full speed.
- You can jump on both legs without pain, and also, you can jump on the affected leg without pain.
Prevention
Preventative measures are necessary to avoid an ankle sprain becoming a chronic injury. Your risk of re-injury increases for at least six to twelve months after an ankle sprain. Both neuromuscular and prophylactic techniques can be used to reduce the incidence of reversal sprain re-injury.
There are many options for prophylactic measures, including taping and bracing. Prophylactic options provide support for the ankle joint and full ROM (range of motion). They are temporary solutions. Neuromuscular training aims to restore protective reflexes and strengthen joint ligaments.
Although there is some evidence that neuromuscular training can prevent injury from recurrence after intensive training, it is not common to see immediate results.