What is an Ankle Sprain?The most common type of ankle injury is an ankle sprain.
A sprain of the ankle occurs when the ligaments, normally on the outside of the ankle, are stretched beyond their normal range.
Ankle sprains are very common and most occur while pivoting during sports such as soccer that involve a lot of turning. Occasionally, we see individuals who slip off the edge of a curb or while walking down the stairs.
Symptoms of an Ankle Sprain
An ankle sprain can vary significantly in terms of symptom severity. Generally, the ankle will swell & become painful to touch. Often times the ankle will turn purple and this can migrate down to the bottom of the heel. It will be difficult to walk on the ankle in many cases. Extreme ankle pain may indicate a potential fracture in the area.
Causes of Ankle Sprains
Commonly ankle injuries occur when someone is running & plants their foot on an uneven surface, which causes the ankle to roll inwards. This roll pulls the ligaments beyond their normal range & causes a tearing of the ligament.
An associated click or popping sound at the ankle may be reported. Like most injuries, an ankle sprain can be complicated by other ankle injuries, which can be easily missed. It is our experience that injuries to other structures and ligaments around the ankle can often give rise to ongoing issues for some athletes if inadequately rehabilitated.
A poorly rehabilitated ankle sprain can give rise to future injury down the line and is something that is commonly encountered in athletes with recurring ankle sprains & also knee or hip pain.
The ankle is a particularly sensitive structure. This is due to the fact that the entire body weight is transferred through the ankle with each step.
Treatment of an Ankle Sprain
Should I Ice My Ankle?
Traditionally, the recommended acute treatment of an ankle sprain would apply the R.I.C.E protocol, that is Rest, Ice, Compression & Elevation. This perceived wisdom has been debated in more recent research. Indeed, the wisdom of blocking the bodies natural response to injury would seem counter-intuitive.
When the evidence base for ice application is reviewed, it is shown to be far from overwhelming. Dr. Mirkin, the man responsible for developing the R.I.C.E. (Rest, Ice, Compression & Elevation) protocol has since altered his opinion and stated that the protocol is unlikely to be best practice in dealing with an injury.
Decreasing inflammation is the proposed goal of ice application; however, the question is: is inflammation harmful? We do know that inflammation is a key component of the healing process and without it there would likely be inadequate healing and potentially further tissue damage.
The question is: how much inflammation is too much?
A 2012 paper reviewed the use of ice in acute ankle sprains and concluded that the use of ice in the management of ankle sprain is ‘based largely on anecdotal evidence’ and that ‘insufficient evidence is available from randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults.’
How Early Should I Exercise After an Ankle Sprain?
Early movement and exercise is now recommended and the rest period should be kept to a minimum. After a brief period of rest, the athlete should commence controlled movement of the injured ankle and, only in severe cases, should crutches be used.
Many athletes can commence controlled exercise of the joint within 48 hours. The initial goal is to decrease pain & swelling so that the athlete can progress on to weight-bearing exercise as soon as possible.
Sports people that rush back to sport after this injury are at much greater risk of re-injury and thus put themselves at risk of a prolonged period out of their chosen sport. It is not simply a case of getting the swelling down and resting the injury. A graded exercise rehabilitation programme is vital to optimise recovery from the ankle sprain and to prevent recurrence. Poor initial rehabilitation can create an environment where repeated injury may occur and it becomes an ongoing pattern of re-injury.
This comprehensive meta-analysis of ankle research revealed that “Rehabilitation reduces the risk of recurrent ankle sprain by 40% compared to usual care or doing nothing” providing strong evidence for the effectiveness of structured exercise programs in preventing future injuries.
Supervised physiotherapy for mild or moderate ankle sprain – PMC
According to this study: Current evidence shows that “just under 60% (299/503) of participants reported a previous injury to their ankle at the start of the study” , emphasizing the high recurrence rate and the critical importance of proper initial rehabilitation to break this cycle of repeated injuries.
We have clinical expertise in managing ankle sprains to help you return to sport or activity as soon as possible. We will provide tailored treatment to address areas of injury & weakness that may have occurred secondary to injury in order to prevent recurrence once you return to activity.
Ref: Collins NC. Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emerg Med J. 2008 Feb;25(2):65-8. doi: 10.1136/emj.2007.051664. PMID: 18212134. https://pubmed.ncbi.nlm.nih.gov/18212134/
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