Welcome to the fist in a new series of short blogs that look in a little detail at some of the common injuries we come across in the clinic. I will give a little bit of info about the injury, some of the common causes and then some ideas on treatments and rehabilitation.
The first injury we are going to discuss today is sprained ankle (or rolled ankle). This is an incredibly common injury and can happen to anyone, whether involved in sports or not. Sometimes just stepping of the pavement, one wrong step can cause the ankle to roll over. More commonly we see it in the clinic as a sports related injury, typically in sports that involve jumping for a ball. In fact ankle injuries are the most common injuries seen in GAA players. Typically the player will jump for a ball and land with the foot in an excessively turned in position. So what exactly happens to the ankle when you roll it or sprain it?
At the ankle joint we have a cluster of bones that are held together with lots of ligaments. We have the lower leg bones, the tibia and the fibula. We also have the heel bone, the calcaneous and the talus. When an ankle sprain occurs usually there is damage done to the ligaments that hold these bones in place where they form joints. In more serious cases we will see some bone bruising or even fractures to the bones themselves. It is much more common to damage the lateral (or outside) side of the ankle and the most commonly injured ligaments are the calcaneofibular ligament or the anterior talofibular ligament (almost 90% or ankle ligament damage is to the ATF ligament). Typically diagnosis of ankle sprains is relatively straightforward due to the common occurrence of such injuries. Scans are not usually necessary, except maybe in very serious cases where there is suspected cartilage damage or damage to the ankle joint.
The main symptoms you can expect with an ankle sprain include pain, swelling and bruising in more severe cases. Initial treatment should include icing in the early stages to try and reduce swelling and in more severe cases the ankle may need to be strapped. If necessary, weight bearing should be avoided with the use of a crutch. Compression can be applied and if possible keep the leg elevated as much as possible in the first 24-36 hours (the RICE protocol).
Manual therapy will involve trying to reduce the swelling at the joint as well as restoring range of motion. The peroneal muscles, which are on the outside of the leg, are often damaged or stretched when someone rolls their ankle and these muscles will also be focused on during treatment of a sprained ankle. A primary focus of a treatment plan should be progressive rehabilitation. An ankle sprain can cause instability at the joint and leaves the ankle more prone to future sprains. Rehab should focus on improving strength, coordination and balance at the ankle joint. As soon as pain allows, exercises should be started that challenge the structures that surround the ankle joint. These could include calf/peroneal strengthening with resistance bands, and single leg balance exercises that challenge balance and proprioception. Then, when ready, a return to sports specific training can be slowly introduced. The best rehab plan should be specifically tailored to the individual athlete so rather than giving a generic plan, it is best to work with a therapist to put a plan in place for you own specific needs. Depending on the severity of the injury, most minor cases will allow a return to sport in 1-2 weeks with more severe cases taking up to 3 months.
This common injury can be frustrating but with a sensible treatment and rehab plan and full return to training can be made. As ever, if you are in doubt about an injury, always talk to a qualified professional to get the best advice for your specific condition. I hope you find this article useful, and keep an eye on this page for our next Injury Spotlight article next week.