Very rarely do we find a grown adult who has not yet suffered from a sprained ankle in their life(1). The injury is common not only in athletes but also in the general population as well (6).
Because of the common belief, that sprained ankle is not a serious condition, the injured do not seek professional help and therefore they do not rehabilitate their ankle correctly which speaks to the fact that a large 70% of those, who have suffered a sprained ankle injury in the past, suffer from it later as well (5).
Recurrence of instability in the ankle, pain, and functional impairment occurs up to two years after the initial injury (6) The fact that ankle sprain is not such an innocent condition is also shown by the fact that in, 20% of cases the articular cartilage is damaged, which, with repeated sprains, can lead to the formation of osteoarthritis (2).
Anatomy of a sprain ankle
The ankle is divided into the upper and lower ankle joint.
The upper ankle joint is formed by the talus below and fibula as well as the tibia above (1). Bones are shaped in a way that they allow raising and lowering of the foot (6). The lower ankle joint is between the talus, the calcaneus, and the navicular bone, which allows the foot to be rotated outwards and inwards.
The foot consists of 26 bones which in addition with muscles and ligaments form 33 joints.
A sprained ankle can lead to serious ligament damage
A vast 85% of all sprained ankle injuries occur when both feet are turned inwards in an “arrow” shape, which is professionally called an ankle inversion sprain with plantar flexion (4).
Towards this mechanism contributes congenital foot arch which is either high or shortened (4). When an inverted ankle sprain occurs, it damages ligaments on the lateral side of the foot in 85% of the cases.
Most commonly damaged ligaments are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL) (1).
If the foot turns too far outwards in the event of an injury, which is called eversion, there is a high chance of deltoid ligament damage, which lies upon the medial part of the foot.
There are about 5% of this kind of sprains (1). There are also so-called high ankle sprains, in which syndesmotic ligaments are damaged. The mechanism in such injury is rotation of the ankle, which frequently occurs in contact sports, contradictory to the inverted ankle sprain, which usually happens in non-contact conditions (8).
Sprained ankle symptoms
Consequences of sprained ankle appear immediately after the injury. We notice:
- movement impairment,
- reduced functionality and
- ankle instability.a (1,6)
How long the consequences last and how serious they are, depends on the greatness of forces that acted upon the joint (6). Ankle sprains are divided into three categories depending on the intensity of the injury:
- The 1st degree of injury represents an overstretched ligament without a rapture. There is swelling with minimal functionality loss of the ankle. The most important characteristic of such injury is that the ankle can be fully burdened shortly after the injury.
- The 2nd degree represents partial rupture of the ligaments. We notice more swelling, we notice formation of bruises, the functionality impairment of the ankle is moderate, we might notice instability of the ankle, and burdening the leg presents a problem.
- The 3rd-degree injury presents total rupture of ligaments with immediate and severe swelling, noticeable are large bruises. Joint is unstable and unable to be burdened.
Is a visit to the doctor necessary?
Yes, you have to visit a doctor. They will evaluate the degree of sprain, palpate the affected area and use specific tests. That way they could dismiss more serious conditions such as fracture, sprain, neurological deficits, and circulatory disorders. At suspicion of this type of pathology, magnetic resonance or ultrasound diagnosis is performed (8).
In case of more serious complications such as fracture of bones, damage to the cartilage, or chronic instability of joint, a surgical procedure is performed. (1,2)
Have you ever heard of the acronym RICE (Rest, Ice, Compression, Elevation), used as first line acute-stage treatment of musculoskeletal injuries?
The concepts of rehabilitation are evolving in tandem with the fairly rapid advancement of sports science. Indicating a more contemporary approach to these kinds of injuries, a new mnemonic acronym has arisen, called POLICE.
Does this imply that you must remain completely still following an ankle sprain injury? Not at all! As a result, this new keyword was created, which reads as follows:
P = PROTECTION
O = OPTIMAL
L = LOAD
I = ICE
C = COMPRESSION
E = ELEVATION
Importance of protecting ankle sprains
It is critical to avoid further tissue damage in the first few days after an injury, which means adequate rest is required. This, however, does not mean that we must stay completely still (7). It is fitting to use functional braces in the first few weeks because they facilitate and encourage movement while reducing the possibility of re-injury (8).
Optimal load is more important than rest
Because bones, tendons, ligaments, and muscles all require a certain amount of load to regenerate, optimal loading will encourage healing (7). This is the most important step in recovering from an ankle sprain.
Proper gradual loading requires a thorough understanding of kinesiology and physiotherapy; thereby, do not attempt rehabilitation on your own; instead, seek professional assistance.
During the acute phase of rehabilitation, i.e. the first few days after a sprained ankle, we perform exercises without loading. It can be as simple as raising and lowering the foot while lying down, circling the foot, or turning the foot outwards and inwards.
While sitting with your feet on the floor, gradually add weight to the injured leg, increasing the intensity over time. In the middle stage, we will intensify the rehabilitation program by increasing the load on the leg, as well as exercises to strengthen the calf muscles and gain full range of motion, as well as proprioceptive exercises.
The final phase is the recreation of daily activities or, in the case of an athlete, sport-specific exercises. The ankle must be fully functional, mobile, and stable at the end of rehabilitation (8).
Cooling is very important
fCooling slows tissue metabolism, preventing excessive swelling. Cooling also lessens pain perception, which can significantly reduce the use of analgesics. It is critical to remember that ice should only be used in the first 48 hours after an injury. Ice packs should never be used on bare skin and should never be left on for more than 20 minutes at a time (7).
Ankle sprain recovery also includes compression and elevation.
Compression and elevation of the injured ankle, in addition to ice and movement, will help reduce edema and relieve pain. An elastic bandage is wrapped around the ankle, as well as up the shin and towards the knee (7).
How can the Medicofit clinic help you?
As previously stated, many injured people return to physical activity quickly (often too quickly), and up to half of all injured people do not seek professional care.
Inadequately repaired injuries, poor rehabilitation or no rehabilitation at all can result in repeated sprains and the development of chronic ankle instability, which can lead to other problems (6).
In our physiotherapy unit we use manual techniques to effectively control pain, reduce muscle tension and restore range of motion. Local soft tissue mobilization, trigger-point therapy of the calf muscles that enable ankle movement, ERGON techniques, transverse friction, and other manual techniques are used in the Medicofit clinic for ankle sprain rehabilitation (3).
Ultrasound therapy can be used on damaged ligaments right away, as its mechanism of action (transmitting high-frequency sound vibrations deep into the tissue) effectively eliminates pain, speeds up healing, and prevents tissue scarring (4).
Tecar therapy has also been shown to be effective in triggering the body’s natural self-healing mechanisms and accelerating regeneration processes. Tecar therapy also improves blood and lymph flow, resulting in more efficient delivery of oxygen and nutrients to the damaged area’s target cells (3).
At Medicofit clinic, our kinesiotherapists will design a therapeutic exercise program for you that will progress gradually to achieve complete ankle functionality, as well as painless and confident movement. The Medicofit clinic is aware that sprained ankles are a serious injury that needs proper rehabilitation or they risk having long-term negative effects.