Ankle Sprain     

Ankle sprain is one of the most common and frequent injuries among athletes and non-athletes of all ages.

It is common among people that a person whose ankle is sprained once, will continue to suffer from it for the rest of his or her life. Is that true?

Does ankle sprain not treat and become a recurring chronic injury? Will pain and imbalance continue to accompany the injured person?

What is the ankle sprain?

Ankle sprain is a stretching or tearing of the ligaments that hold the ankle in place.

The ankle joint: It is the joint that connects the foot to the lower leg and always exposes to be sprained, but why?

Because the stability of any joint depends on three important components:

First: the shape and composition of the bones that make up the joint.

Second: the ligaments attached to the joint that allow a certain range of motion.

Third: the muscles that move the joint in a certain range of motion.

Therefore, any defect or injury to one of these components may result in the instability and imbalance of the joint and make it more susceptible to injury.

Severity of ankle sprains:

The severity of ankle sprain varies depending on the degree of the ankle ligament injury and is divided into three grades:

• Grade I (mild): stretch of ligaments without rupture.

• Grade II (moderate to severe): partially torn of one ligament or more.

• Grade III (very severe): all ligaments are completely torn.

How does an ankle sprain occur?

Ankle sprain occurs in one of the two ways, first and most commonly one, when the foot is flipped inward (inverts) in such a way that the ankle ligaments stretched beyond their normal range of motion, causing the soles of the foot to face the other foot, usually causing injury or tearing to the ligaments in the outer part of the ankle. The other and less common way, when the foot is turned outward (everts), and this injury causes damage to the ligaments in the inner part of the ankle and may be accompanied by other injuries, such as fractures in the leg bones or sprained upper ankle.

Causes of ankle sprain:

Ankle sprain can occur in one of the following situations:

• Walking or training on uneven surface or ground, especially when pressing a rock or getting out of the pavement edge.

• Falling with inverted or everted foot.

• Landing in an abnormal foot position after jumping.

• During sports activities, with frequent and rapid trend changes, jumps and docking with the players of the opposing team, especially in the sports of football, basketball and volleyball.

• Wearing inappropriate shoes such as pointed shoes.

What are the symptoms associated with ankle sprain?

Mild symptoms:

• Slight pain

• Slight swelling

• A slight loss of ankle function may occur.

 

Moderate to severe symptoms:

• Moderate pain

• Swelling and sensitivity of the affected tissues

• Mild to moderate loss of ankle function

• Mild to moderate instability in the ankle

• Often internal bleeding

• Weight bearing problems

 

Very severe symptoms:

• Excessive pain sensation

• Clear swelling

• Hematoma

• Major loss of ankle function

• Abnormal movements and clear ankle instability

• Internal bleeding

• Imbalance

• Weight intolerance

What is the treatment of ankle sprain?

Grade I ankle sprain treatment:

In the case of a grade I ankle sprain, you can manage the injury at home by following these four points:

1. Rest: Rest the ankle and do not move it and also avoid any activities that may cause pain.

2. Ice: Apply ice to your ankle even if you intend to go to the doctor. The ice will help relieve any inflammations and stop bleeding in the case of a slight lace tear.

3. Compression: Apply the elastic bandaging and foot dressing from the fingers to the middle of the leg to reduce swelling around the ankle.

4. Elevation: elevate the ankle above the body level to reduce injury and swelling.

After getting rid of pain and swelling, you can start exercising and training with a gradual increase.

 

Grade II ankle sprain treatment:

In the case of a grade II ankle sprain, you can apply the previous four points with a splint or special shoe so you can walk comfortably.

But you need physical therapy to help reduce the swelling, maintain the range of joint movement, and gradually strengthen the muscles around the ankle (and thus prevent recurrence of sprains in the future).

 

Grade III ankle sprain treatment:

In case of a grade III ankle sprain, you should seek immediate medical attention.

The ankle is stabilized into a splint that can be removed, or in a shoe, and most patients need crutches.

Some may need surgical intervention, but experts find that applying surgery isn’t better than treatment without it.

Physical therapy is necessary to restore movement, strengthen muscles and improve balance before the patient resumes stressful activity, and physical therapy can also speed up recovery.

                                

What is the role of physical therapy in cases of ankle sprains?

Go to the physiotherapist if your injury is grade II or grade III.

Physiotherapy helps you to:

1. Speed up the healing

2. Reduce swelling

3. Relieve pain

4. Maintain the motor field and restore movement

5. Strengthen the muscles around the ankle, and the muscles that keep it steady and stable

6. Improve body balance

7. Prevent recurrence of ankle injury

Physical therapy modalities:

1. Different manual therapy techniques

2. Strengthening exercises for ankle muscles

3. Strengthening exercises for ankle stabilizers

4. Balance training

5. Proprioceptive training

Written by,        

Dr. Alaa Ramadan

References

• Fong, D. T. P., Hong, Y., Chan, L. K., Yung, P. S. H., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports medicine, 37(1), 73-94.
• Ivins, D. J. (2006). Acute ankle sprain: an update. American family physician, 74(10), 1714-1720.
• Smith, R. W., & Reischl, S. F. (1986). Treatment of ankle sprains in young athletes. The American journal of sports medicine, 14(6), 465-471.
• Osborne, M. D., & Rizzo, T. D. (2003). Prevention and treatment of ankle sprain in athletes. Sports Medicine, 33(15), 1145-1150
• van der Wees, P. J., Lenssen, A. F., Hendriks, E. J., Stomp, D. J., Dekker, J., & de Bie, R. A. (2006). Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: a systematic review. Australian Journal of Physiotherapy, 52(1), 27-37..
• https://www.mayoclinic.org/ar/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231