What Is An Ankle Sprain And How Do I Manage It?
WHAT IS A LATERAL ANKLE SPRAIN?
An ankle ligament sprain involves damage to one or more of the outside (lateral) ligaments that supports the ankle joint. Ligaments function to provide the ankle joint with stability by attaching from one bone to another. They also provide a lot of information to the brain about what the joint is doing. If these ligaments ever become over-stretched (usually during a trauma), it results in a complete or partial tear of the ligament fibres. There are many ligaments in the ankle region but those on the lateral side are more commonly affected. They are listed below:-
- Anterior talofibular
- Posterior talofibular
- Anterior talofibular
MECHANISM OF INJURY – HOW DOES IT OCCUR?
Sprains to the anterior talo-fibular ligament more commonly occur as a result of trauma. Usually a sudden awkward rolling in movement (inversion) of the ankle occurs, followed directly by pain over the front and side of the ankle. Some people find that they are able to walk on the injured foot following injury, where as others will find that they are unable to walk on the ankle at all. Injury commonly occurs during the landing of a jump when the body suddenly twists or during movements with quick changes of direction. A ‘snap’ or ‘tear’ may be heard however but is not as indicative of type or severity of injury as in the case with knee injuries.
Typical symptoms of a lateral ankle sprain include:
- Pain: Felt on the lateral (outside) part of the ankle with certain or all movements. It may be tender directly over the Anterior Talo-fibular Ligament when touched.
- Instability: If you are able to stand up on the ankle, it may feel unstable as though it will give way. This is due in part to the ligaments no longer being able to support the ankle and also the effects of swelling in the joint space.
- Swelling and/or bruising: May develop over 24 hours post injury due to the natural inflammatory response of the body to the injury. Bruising is indication of bleeding into the tissues and may track up the calf and into the foot if bad.
- Decreased range of motion: The ankle will have decreased movement due to all of the above symptoms. If symptoms persist the whole of the lower limb and core can be affected as the body adapts to moving with pain.
Diagnosis of a lateral ankle injury requires a through physical examination by your physiotherapist. The physiotherapist will examine the area to locate swelling, bruising and tenderness. Touching directly over the anterior talofibular ligament would be painful if an ankle strain has occurred. A slight discontinuity may even be felt over the anterior ligament. Additionally it is necessary to perform stress testing of the ligaments to determine whether the ligament has been torn. This is done by moving the bones of the ankle in a controlled way to determine if there is any abnormal motion at the joint.
X-rays are often performed to check for the possibility of a chipped bone or fracture. They must include the base of the fifth metatarsal of the foot to exclude possible fracture at this point.
MRI (Magnetic Resonance Imaging) and CT (computer tomography) scans may be used to further investigate type and extent of sprain the sprain. These image techniques give the best image of soft-tissue structures including ligaments. They may also be used to look for osteochondral fracture which may not appear on initial X-ray.
Below are the main aims of treatment:
- Reduce inflammation- rest/ ice / compression / elevation / inflammatory medication (after 48hrs)
- Regain normal range of movement again with gentle mobilisers
- Regain strength at the ankle, foot and even hip
- Train proprioceptive feedback and balance to provide stability around the joint.
- Soft tissue release and home stretches for the calf and/or hamstrings and hips.
- Standing work to integrate the ankle into the leg and trunk
- Jump training to return fully to class
Taping can also be useful during the early stages of rehab and will be directed by your therapist.
If the ligament rupture is more severe, surgery may be indicated, but a lot of the time only a walking boot maybe required.
There are still plenty of exercises that can be done even when in a boot!
Recovery time is dependent on the severity of the injury. If only a mild sprain, pain can dissipate within a few days and the dancer may continue in class. For more severe sprains recovery may take a longer time and require more rehab. Exercise modification is important while attempting to settle symptoms and may include strategies such as reducing jumps/turns or wearing more supportive shoes for class.
It may just be a case of bad luck that you have an ankle inversion injury but sometimes an assessment/screening at your local physio clinic, especially one versed in the requirements for dance, can assist in picking up any areas of weakness before they become problematic. This is the case especially if you have had a couple of minor sprains in the past.