Ankle Sprain

What is it?

The ankle joint is made up of 4 bones.  The shape of each bone helps to make the joint stable.  Stability around the joint is increased by the ligaments, which are bands of strong connective tissue that prevent unwanted movement.

When the ankle twists, the ligaments usually prevent the joint from moving too much.  An ankle sprain occurs when one of the supporting ligaments is stretched too far or too quickly causing the fibres of the ligament to tear and bleed into surrounding tissues which results in pain, swelling and tenderness.

Signs and Symptoms

•       Pain – at rest and/or with movement

•       Bruising

•       Swelling

•       Unable to put weight through the foot

Mechanism of Injury

• Ankle sprains occur when the sole of the foot is turned forcefully inwards or outwards.  This can occur when you step or jump onto an even surface or when the foot is planted and the body twists over it.  Ankle sprains are common in sports that involve sudden stopping, twisting or turning such as netball and soccer.

• Most sprains occur when the foot is turned down and inward.  This causes damage to the ligaments on the outside of the ankle.

• Proprioception refers to your awareness of the position of your body in space.  Healthy ligaments have nerves which send information to your brain about the position of a joint.  The brain then sends messages back to the muscles which control movement at the joint. 

• When a ligament is injured, these nerves are also damaged.  Balance exercises, will help retrain the nerves as they repair themselves and re-strengthen the muscles which help to support the joint.

Common Management Techniques

Initial Management

During the first 24-48 hours post injury, the R.I.C.E principle should be used to minimise swelling and increase the speed of recovery.

• REST: try and avoid putting weight through the injured ankle for 24 hours or longer if necessary.  Crutches may be required in severe cases.

• ICE: put ice on the ankle for 20 minutes every 2 hours to ease the pain and reduce the swelling.  You can use ice packs or frozen vegetables wrapped in a wet tea towel.

• COMPRESSION: put pressure on the painful area using a bandage.  This will help to reduce the swelling.  If you feel pins and needles or your skin turns blue below the bandage, it is too tight and must be loosened immediately.

• ELEVATION: Lie down with your ankle resting on pillows so that it is above the level of the heart.  This helps gravity to bring down the swelling.

• Avoid H.A.R.M – Heat, Alcohol, Running and Massage all of which increase the swelling.

Prognosis

Some people suffer from recurring ankle sprains. This can be caused by a number of factors working in combination, including:

• Ligament scarring and excess looseness, as a result of previous ankle sprains.

• Insufficient rehabilitation from previous sprains. This can lead to weak muscles surrounding the ankle joint, especially on the outside.  It can also cause decreased capacity to judge where your foot is in relation to your leg.  This is called a proprioceptive deficit.