First aid for an ankle sprain
Ankle sprains are a common injury whether on the sporting field or even during our everyday lives. It can happen due to sudden changes in direction during a sporting activity or sometimes when missing a step whilst going down the stairs. To determine if there is a need for a visit to the hospital, the following few questions should be considered.
- Is it difficult to bear weight on the injured limb?
- Did you hear a loud crack or pop when you injured yourself?
- Any visible bony deformities?
If you have answered YES to all three of the above, it is advisable to call 995 for help!!
To help you with a provisional diagnosis in determining whether you have an ankle sprain, you would normally have one or more of the following signs.
- Localised redness and swelling that can appear on the inside or outside of your ankle
- Feelings of instability when walking
- Loss of mobility/ stiffness at the ankle
- Pain that is localised, usually on the outside of the ankle
- Localised tenderness when upon palpation on the outside of the ankle over the swollen area
- Difficulty going up and down the stairs
Initial treatments of ankle sprains would require PEACE & LOVE:
Protection – avoiding painful activities and movements
Elevation – keeping the limb above the level of the heart whenever possible
Avoid Anti-inflammatories – unless pain is unbearable, anti-inflammatories are not advised as it might slow down recovery
Compression – using an external bandage to keep the injured ankle compressed
Education – understanding the injury would lead to better outcomes
Load – progressive load to the ankle and resumption of activities
Optimism – maintaining a positive attitude towards the recovery process, most ankle sprains do well without surgery!
Vascularisation – with advice from your physiotherapist, start a cardiovascular activity
Exercise – progressive exercise that is specific to an ankle sprain will ensure good recovery
How can Physiotherapy help with an ankle sprain?
Your Physiotherapist will thoroughly examine your ankle ligaments and determine which are the affected movements. This would include an assessment of the range of movements in your ankle and foot as well as your calf strength and the flexibility of the surrounding muscles. The role of Physiotherapy is to ensure that the ligament is adequately protected and the muscles surrounding the ankle are strong enough to return back to function or sport.
Treatment for an ankle sprain may include but is not limited to:
- Advise and education pertaining to your condition
- Soft tissue therapy
- Movement with mobilisation
- Heat therapy
- Shockwave therapy
- Taping to support the ankle
- Movement training
- Returning to sport training
- Personalised home exercise program
Why do you need Physiotherapy after an ankle sprain?
No ankle sprain is a simple ankle sprain. This is evidenced by the high propensity for the development of long-term injury-associated symptoms such as persistent swelling and pain. Other symptoms include a subjective reporting of ankle joint instability, as well as ‘giving-way’ of the ankle joint which, along with recurrent lateral ankle sprain injuries, constitute the characteristic features of chronic ankle instability. As many as 40% of individuals who incur a first-time lateral ankle sprain injury can be expected to develop chronic ankle instability as early as 12 months after their injury. Don’t take your seemingly innocuous sprain lightly!
Recovery time after an ankle sprain
The duration of recovery depends greatly on the severity of the ankle sprain. For more severe ankle sprains, a longer recovery time should be expected. In general, the time taken for recovery of lateral ankle sprains is as follows:
- Grade 1 (mild) ankle sprains: 3 to 5 weeks
- Grade 2 (moderate) ankle sprains: 4 to 6 weeks
- Grade 3 (severe) ankle sprains: 3 to 6 months
For syndesmotic “high ankle” sprains, the rehabilitation period is usually longer than that of lateral ankle sprains. Studies have shown that syndesmotic sprains may need twice the amount of time to heal as compared to grade 3 lateral ankle sprains.
The ligaments undergo a healing process that consists of 3 distinct phases: the inflammatory phase, the reparative phase, and the remodelling phase.
Inflammatory phase of an ankle sprain
The inflammatory phase typically lasts between 24 and 72 hours. In response to the injury, inflammation occurs, beginning the recovery process. White blood cells migrate to the site of the injured ligament to clear debris and damaged cells in a process called phagocytosis. Phagocytosis also promoted the formation of new blood vessels that facilitates ligament repair.
After the inflammatory phase, within 3 to 5 days following the sprain, the reparative phase of healing begins. During this phase, the damaged ligament is repaired with new connective tissue. By 10 to 14 days post-sprain, the ruptured ligaments are reconnected with disorganised collagen, allowing the ligament to resist low-level tensile forces.
Remodelling phase of an ankle sprain
The remodelling phase occurs after the reparative phase and typically starts between 15 and 28 days after the ankle sprain. During this phase, the disorganised collagen fibres that connect the torn ligament mature and become organised. This allows the ligament to regain approximately 60% of its tensile strength by 3 weeks post-sprain. Pre-injury strength may be recovered 3 months after the sprain.
Exercises for ankle sprains
After an ankle sprain, exercise is essential to improve ankle strength, movement and balance. This improves ankle stability and reduces the time to return to pre-injury activity. Exercises for ankle sprain typically consist of:
- Active range of motion exercises
- Strength training
- Neuromuscular training
- Balance training
- Plyometric drills