A sprain is an injury to the ligaments and capsulo-ligamentous structures of a joint, and does not involve muscles or tendons. In the ankle joint, the mechanism of injury is a sudden inversion movement — the foot twisting inwards. This mechanism damages the lateral ligament. Less commonly, a sprain occurs through the opposite mechanism — the foot twisting outwards — in which case it is the medial ligament that is injured. It is a particularly common injury and is graded according to the degree of force applied to the ligaments, ranging from a mild injury — Grade 1 — through a partial tear — Grade 2 — to a complete tear — Grade 3. The injury can occur from:
• A fall that throws the body's weight onto the ankle and twists the foot
• Landing after a jump or taking a step
• Walking on uneven surfaces
• A knock to the foot during sporting activities
Symptoms
The symptoms experienced by the patient depend on the severity of the injury and include:
• Pain, especially when bearing weight on the limb
• Pain on palpation
• Bruising
• Swelling
• Restricted range of movement in the joint
• Possible instability of the joint
In more severe injuries, the patient may feel a popping sensation at the moment of injury.
Risk Factors
The factors that increase the likelihood of sustaining an ankle sprain are:
• Sports involving jumping and sudden changes of direction
• Uneven terrain
• A previous ankle injury
• Poor physical condition
• Inappropriate footwear
Complications
If an ankle sprain is not treated appropriately, chronic conditions may develop, such as:
• Chronic ankle pain
• Ankle instability
• Arthritis
• Recurrent injuries
How Can Physiotherapy Help
The priority is reducing pain, which in some patients can be extremely acute. This is achieved through a combination of treatment options, such as specialist massage and the application of electrotherapy, which will reduce pain in every case. The limb is then mobilised through specialist exercises. Gradually, as range of movement increases, strengthening exercises are introduced to rehabilitate the foot and protect against possible future injuries. The interventions applied are:
Differential Assessment
Assessment by a Physiotherapist is essential in order to rule out — or confirm — the presence of a fracture and to arrange a referral to a Doctor where necessary. The assessment requires a detailed history, a description of the mechanism of injury, and the performance of clinical tests.
What Can I Do Myself if I Have an Ankle Sprain?
In the event of an ankle sprain, you should do the following immediately:
• Keep the foot elevated to prevent the swelling from worsening significantly
• When sitting, use a support so that the ankle is approximately at the height of the knee
• When lying down, place a pillow under the entire leg so that the ankle is higher than the rest of the body
• Apply ice wrapped in a towel to the ankle for 20 minutes, 4–5 times a day
• Wrap the ankle with an elastic bandage or ankle support for 30 minutes, then leave it free — repeat 4–5 times throughout the day
• Protect the ankle and move with the aid of a support device to avoid placing too much load on it or making any sudden movements
For the treatment of sprains, call PhysioDanali today for specialist advice from a Physiotherapist!
• Rhon DI, Fraser JJ, Sorensen J, Greenlee TA, Jain T, Cook CE. Delayed Rehabilitation Is Associated With Recurrence and Higher Medical Care Use After Ankle Sprain Injuries in the United States Military Health System. J Orthop Sports Phys Ther. 2021 Dec;51(12):619-627. doi: 10.2519/jospt.2021.10730. PMID: 34847698.
• Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002 Apr;32(4):166-73. doi: 10.2519/jospt.2002.32.4.166. PMID: 11949665.
• Denegar CR, Hertel J, Fonseca J. The effect of lateral ankle sprain on dorsiflexion range of motion, posterior talar glide, and joint laxity. J Orthop Sports Phys Ther. 2002 Apr;32(4):166-73. doi: 10.2519/jospt.2002.32.4.166. PMID: 11949665.
• Mayo Clinic. Spained Ankle.