Sprained Ankle: A Full Recovery
You don’t have to play sports to sprain your ankle. A sprain is an overstretch or tear of the ligaments which attach bone to bone. Sometimes other soft tissues are involved but most often it is the three ligaments that lie on the outside of the ankle attaching the fibula to the foot. The cause of injury doesn’t have to be excessive. Simply rolling inwards on your ankle, usually when you have your toes on the ground and heel up, can result in pain and then swelling and bruising on the outside of the ankle which migrates down to the toes.
For diagnosis sprains are classified from Grade l to 3.
Grade 1 – a mild sprain which settles in two to three weeks but needs to be rehabilitated properly to prevent joint stiffness, ligament laxity, muscle weakness or tightness plus reduced proprioception.
Grade 2 – the ligament is excessively stretched or partially torn causing extensive swelling and bruising. Recovery takes four to six weeks and rehabilitation becomes more complex and extensive.
Grade 3 – the ligament is completely ruptured resulting in instability and needs immobilising. It may be the bone is fractured which is difficult to differentiate without an x-ray. If you are unable to bear weight or if there is significant swelling or deformity, you should seek medical treatment.
Treatment in the first instance is usually to follow the RICE regime. Initially it involves resting, protecting and reducing swelling of your injured ankle. Physiotherapy helps with pain relieving techniques, massage and strapping to assist you during this painful phase and advises on pain-free exercises.
As the pain settles the focus changes to restoring your ankle’s flexibility, range of motion and strength. Scar formation takes at least six weeks and the aim in this time is to achieve a normal functional length of the ligament and muscles with specific lengthening and strengthening exercises. One important aspect of rehabilitation that is often overlooked is proprioception ie our sense and awareness of the position of our body parts. It is closely linked to balance and helps to reduce the risk of re-injury. Located within the muscles, tendons and ligaments are tiny sensors which relay information about joint position, pressure and muscle stretch to the brain. If you’ve ever automatically recovered as you’re about to twist your ankle then this is the proprioceptors working automatically to prevent further injury.
Proprioception is improved through exercises which begins as soon as possible after an injury. Generally in lower limb injuries, this is as soon as full weight bearing is possible. This kind of exercise can start very simply, without the need for equipment using single leg balance exercises, closing your eyes and then progression to a wobble board.
All in all, with correct treatment, recovery from a lateral ankle sprain should be full and not recurring so you have confidence to return to everyday activities or chosen sport.