A rolled or sprained ankle is one of the most common injuries we see in ball sports. The injury occurs when an athlete needs to change direction quickly. At times the ankle rolls over on the foot, ultimately stressing the stabilising structures on the outside of the ankle. It is something we've all done from time to time, but if the force is great enough, the ligaments can become over stretched and leave us susceptible to further sprains. In some cases the bone can be bruised or fractured which may need a surgical intervention.
Typical symptoms of an ankle sprain include
- pain around the ankle
- swelling and bruising, usually around the outside of the ankle
- limping, at times an inability to weight-bear on the injured ankle
The structures that provide stability to the outside of the ankle include muscles (Peroneals) and ligaments (ATFL, CLF, PTFL). When an ankle is assessed by a physiotherapist, it is graded on a system between 1-3. Grade 1 sprains are mild and result in microscopic over-stretching or tearing of the ligament fibres. These sprains usually present with tenderness, swelling, and possibly a slight limp. Grade 2 sprains are moderate and result in significant over-stretching or tearing of the ligaments. Patients often present with tenderness, swelling, bruising, reduced strength and may be limping. Grade 3 sprains are severe and are a complete rupture of the ligament. Significant tenderness, swelling, bruising and instability are present in these ankles, which usually need referral to an Orthopaedic Surgeon for repair.
At your first assessment, your physiotherapist will determine which structures are damaged, to what extent they are damaged, and rule out a fracture using the OTOWA Ankle Rules. Initial management of an acute ankle sprain may follow the RICE principle
Rest - offloading the ankle, limiting the amount of walking and possible prescription of crutches or a moon boot to aid with healing.
Ice - applying ice to the area to manage swelling and pain for the first 48-72 hrs.
Compression - applying compression to the ankle to help limit swelling and stabilise the joint.
Elevation - to aid with swelling management.
Once the acute symptoms settle and your physiotherapist has ruled out any articular injuries, retraining your muscle strength, balance, mobility and proprioception are essential to restore your ankle to its best condition. To allow for an earlier return to sport, your physio may also prescribe the use of an ankle brace to reduce your risk of injuring the ankle further. These braces can be weened off when the ankle regains its full function again, however many patients continue to wear their braces as a preventative measure.
At times we see patients that have had a significant sprain that hasn't undergone an appropriate rehab program. These patients of report ongoing pain, swelling and weakness in the ankle despite their best efforts to rest it. These ankles can still be improved upon, but can be more difficult to restore full function depending on the duration of the injury.