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First aid for an ankle sprain

Ankle sprains are common injuries 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. The following questions should be considered to determine if there is a need for a visit to the hospital.

    1. Is it difficult to bear weight on the injured limb?
    2. Did you hear a loud crack or pop when you injured yourself?
    3. 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


    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:

    Recovery time after an Ankle Sprain

    The duration of recovery from previous ankle injury depends greatly on the severity of the injury. A longer recovery time should be expected for more severe cases of ankle sprains. In general, the time taken for recovery from lateral ankle sprains is as follows:

      1. Grade 1 (mild) ankle sprains: 3 to 5 weeks
      2. Grade 2 (moderate) ankle sprains: 4 to 6 weeks
      3. Grade 3 (severe) ankle sprains: 3 to 6 months

    For syndesmotic “high ankle” sprains, the rehabilitation program period is usually longer than that of lateral ankle sprains. Studies have shown that syndesmotic and recurrent ankle sprains may need twice as long to heal 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 remodeling phase.

    Inflammatory Phase

    The inflammatory phase of a sprain typically lasts between 24 and 72 hours. White blood cells migrate to the site of the injured ligament to clear debris and damaged cells and promote the formation of new blood vessels. After 3 to 5 days, the reparative healing phase begins, with the damaged ligament repaired with new connective tissue. By 10 to 14 days, the ruptured ligaments are reconnected with disorganised collagen, allowing the ligament to resist low-level tensile forces.

    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.

    Remodeling Phase

    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 injury, initial treatment and exercise are essential to improve ankle strength, movement and balance. This improves ankle stability and reduces the time to return to pre-injury activity. Rehabilitation exercises for ankle injuries typically consist of the following:

    Active range of motion exercises

    1. Strength training
    2. Neuromuscular training
    3. Balance training
    4. Plyometric drills

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