Ankle pain or injury is a common complaint within sports. The vast majority of the time this comes from a “Rolled”, “Sprained”, or “Strained” ankle. This usually comes from an awkward step or landing, most often in ball sports but can happen during any physical activity. Here we’ll discuss what this injury is, steps you can take to manage it and why and when you should seek a consultation.
Anatomy Of An Ankle Sprain
Our joints are held together by connective tissue called ligaments. A “Sprain” describes the stretching of a ligament beyond its capacity. These can range from a minor stretch with micro-tears to complete rupture. 85-90% of sprains occur to the outside of the ankle due to the foot rolling inward, known as a lateral ankle sprain. This can injure one or all of the anterior-talofibular ligament (ATFL), calcaneofibular ligament (CFL), and/or posterior-talofibular ligament (PTFL). Less commonly is the “medial ankle sprain”, an injury of the deltoid ligament, caused by the foot rolling outwards. Finally we have the “High ankle” or “Syndesmotic” ankle sprain. This involves the group of thick ligaments forming the Syndesmosis, which holds the tibia and fibula (The two bones of the shin) together just above the ankle. This one portends the longest time to return to sport.
How Do I Manage My Ankle Sprain?
You may have heard of “RICE”. Rest, Ice, Compression, Elevation. Evidence for the efficacy of RICE in expediting healing is fairly unequivocal (1). RICE can also sometimes be applied poorly, as absolute rest/immobilisation is against best evidence. What we’d really want is relative rest (Regress training to a level that is non-irritable), with ICE components as needed for pain relief and swelling management. Most recently we have the acronym “PEACE and LOVE” standing for: Protection, Elevation, Avoiding Anti-inflammatories and Icing, Compression, Education, as well as Load, Optimism, Vascularization, and Exercise.
No good evidence exists for kineseotaping, scraping, cupping, dry needling or any other hands-on treatments for ankle sprains (2). They won’t break down scar tissue, effect inflammation or any other mechanisms that some Physios would lead you to believe.
If there is no fracture but the sprain is severe enough, we may recommend to “weight bear as tolerated”, which means to use the injured leg only as much as is tolerable. This might also entail the use of crutches or over-the-counter brace to help offload the joint during the initial phase. It is not a long-term solution, and its best to use the minimum assistive device possible to allow for as much tolerable movement/loading as possible.
What Will Physiotherapy At SPO look like?
Initially a thorough assessment to formally diagnose and grade the ankle sprain, and to rule out the possibility of a fracture. Next, a detailed discussion will be had in regards to goals of treatment. For example, rehab for a powerlifter who only has to stand in one spot will look very different to that of an MMA or field athlete. Goals and pre-injury capabilities will guide our rehab principally. Next we will create and progress over time a custom rehab program with the following features guaranteed:
Promote pain relief
Restore range of motion
Maintain muscular strength and endurance
Maintain or even progress all other important athletic qualities for the strongest return to play possible
Do I Need To See A Doctor?
You should definitely see a Doctor for a likely scan if you test positive for the “Ottowa Ankle Rules”, which flag people with potential fractures:
Inability to take 4 steps immediately after the injury and now
Bony tenderness at the Navicular, base of 5th metatarsal, distal 6cm of posterior edge of tibia or fibula, or medial malleolus
Because we don’t expect the average person to be able to accurately find these bony landmarks my practical recommendation is: If you cannot bear weight on your ankle and/or have bony tenderness anywhere around the ankle.
Do I Need To See A Physiotherapist?
I recommend booking in a consultation if:
You are unable to train/play at your full capacity
You tested positive to the Ottowa Ankle Rules and have/have not yet seen a Doctor
Are unsure about how to manage or modify training otherwise
It has been a recurrent injury
References
https://pubmed.ncbi.nlm.nih.gov/33081510/