Author: Jack Andringa-Bate
So, you’ve recently rolled your ankle? Whether you were playing sports, tripped on a rock, or fell from a ladder, ankle sprains can be very painful. Add in some soft tissue swelling and all of a sudden, you’ve got a foot and ankle that feels and moves like a brick. Now what do you do? This article will help you understand ankle sprains and how treatment should progress from day 1.
Essential Anatomy?
The ankle joint connects the lower limb (consisting of the tibia and fibula bones) to the foot (primarily the talus). This joint is known as the talocrural joint and acts essentially as a hinge allowing the foot to move up and down. The ankle can and does move from side to side (which is called inversion and eversion) through another joint, known as the subtalar joint. Subtalar movements are much more subtle than talocrural movements, although this movement is essential to facilitate activities such as walking.
Movements at the talocrural and subtalar joints are supported by a network of connective tissues known as ligaments as well as through a bounty of muscles that attach to the bones of the foot. These connective tissues and muscles create a support system for the ankle. Ligaments contribute to the passive support system, helping to stabilise the ankle by preventing excessive movement. Muscles contribute to our active support system and also provide stability, in addition to facilitating movement.
What causes an ankle sprain?
In a nutshell, when ankle movement, especially side to side movements like rolling the foot inwards, exceeds the capacity of our support systems (our ligaments and muscles) the support systems can fail, resulting in tissue damage and pain. This is your typical “sprained ankle”, a disruption of one or more of the ligaments that provide passive stability to the ankle. In more severe sprains the muscles that form the active support system may also be damaged.
Although ankle sprains are often traumatic in nature, for example twisting your ankle playing sport, or rolling the ankle when landing from height, certain biomechanical factors can play into the likelihood of you sustaining a sprained ankle. Muscles that surround the ankle such as the peroneal and the calf muscles are important here, as well as higher up the chain including muscles at the knee and even the hip.
Physiotherapy treatment for ankle sprains
Although ankle sprains can be very painful, once a fracture has been ruled out it is important to try and get the ankle moving again as soon as possible. Immediate care of the ankle should follow the acronym POLICE:
Protect - from subsequent damage, the ankle will be weaker following injury so relative rest in the short term is paramount to support tissue healing.
Optimally Load - body tissues often heal based on the stress that is placed upon them, as such the right amount of activity can support effective recovery. The balance between protecting and optimally loading can be tricky, so always seek expert opinion if you have any doubts.
Ice, Compress, and Elevate – these techniques can help to reduce pain and inflammation and are particularly important in the first few days following injury.
Mobility:
Regaining mobility and range of motion at the ankle is critical in the early stages following injury. If a fracture has been ruled out then gently walking on the ankle is a great way to encourage normal range of motion. Other exercises may be prescribed by your Physiotherapist to improve your ankle mobility following an ankle sprain.
Control:
When it comes to ankle sprains control refers to our ability to perceive where the ankle is in space. This is known as proprioception and it is vital to maintaining balance and preventing subsequent ankle sprains. Because this sense of control is often provided by the ligaments that are damaged when you sprain your ankle, exercises to facilitate the improvement and recovery of this sense are important. Your Physiotherapist will guide you through a program of control exercises often starting with single-leg balancing.
Strength:
Muscles that support the ankle, such as the peroneal muscles on the outside of the lower leg, have an important role to play in preventing and managing ankle sprains. Recall that our active support system helps to provide stability and facilitate movement. Muscles around the ankle and even higher up the chain will be targeted to encourage this stability and optimise ankle movement.
In summary, if you have recently sprained your ankle remember these 3 things:
- Once a fracture has been ruled out use the acronym POLICE to guide your early rehabilitation.
- It is safe to load the ankle with gentle activities such as walking even when the ankle is swollen and sore and this in fact may encourage recovery.
- Complete rehabilitation of a sprained ligament will address all elements of mobility, control, and strength to ensure a safe resumption of activities and to minimise the risk of re-injury.
If you are suffering from a sprained ankle, book in with your Physio for a thorough assessment using this link – [Free Initial Assessment]. A rehab program can be designed specifically for you to improve your ankle and get you back to doing what it is you love.
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