Just about all of us have had an ankle injury at some time in our lives, and I’m sure we have been given all sorts of advice about what to do. However, in this edition of our e-newsletter, we share the facts about what it means and what to do.

What is an Ankle Sprain?
A sprain is an injury to a ligament. Ligaments connect bone to bone to help stabilise and support your joints. There are many ligaments in the ankle which can be torn or stretched, depending upon which way your ankle is twisted/ moved.

Sprained ankles, as with all ligaments sprains, are divided into grades 1-3, depending on their severity:
Grade 1:
Mild pain at the time of injury, perhaps able to keep walking or playing sport
Some stretching or perhaps minor tearing.
There may be mild swelling around the bone on the outside of the ankle.
Little or no joint instability of the joint.
Grade II sprain:
Pain++ and difficulty walking or continuing playing sport (carried off field)Moderate tearing of the ligament fibres.
Some instability of the joint.
Swelling++ and secondary stiffness in the ankle joint.
Bruising evident, comes out over the next week
Grade 3 sprain:
Total rupture of a ligament.
Gross instability of the joint. Often thought of as a fractured ankle, unable to weight bear
Severe pain initially followed later by much less pain after the leg is elevated
Severe swelling with extensive bruising.
X ray advised, often fractures accompany these ruptures

The most common type of ankle ligament injury is caused when the foot is rolled in and under the foot and then weight is loaded onto the leg causing the injury. The ligaments most commonly injured are the 3 lateral ligaments (see picture). Often accompanying these injuries are accompanied by damage to the ligament which joins the 2 bones in the lower leg (tibia and fibula). The result of these sprains is that the joint nudges out of alignment which makes walking very painful and difficult.

Physiotherapy Treatment of a Sprained Ankle
Treatment of a sprained ankle can be separated into 3 phases- timeframes will depend upon the extent of the ligament injury.
Immediate / at the time of injury (0-48 hours)
The old addage RICE is the best thing -this aims to reduce the swelling by as soon as possible.
·R is for rest. It is important to rest the injury to reduce pain and prevent further damage.
·I is for ICE. for 20 minutes on 20 minutes off. Repeat this every 2 hours for the first 24-48 hours
·C is for compression – This reduces bleeding and helps reduce swelling.
·E is for Elevation – So put your feet up
Intermediate stage ( 2 days to 2 weeks)
Physiotherapy can help expedite the process by realigning the joint, reducing swelling and regaining range of motion quickly. Returning you to a normal walking gait is our primary aim , whilst providing the ankle with support such that re-injury risk is minimised. Our Physiotherapists will use techniques such as joint mobilisation, manual therapy, electrotherapy and taping techniques.
Rehabilitation/ return to activity (2 weeks+)
This phase incorporates returning to normal gait pattern, stretching tight muscles (such as the calf), improving joint proprioception (high level balance). This progresses to jogging, stair climbing and return to activity. It is important to restore the ankle to full function as quickly as possible and prevent possible secondary issues such as joint stiffness and muscle wasting. If you have had an ankle sprain in the past and your ankle is still not 100% then start with some of these exercises.

Ankle alphabet
Move ankle in all directions. Trace all the letters in the alphabet . Make the letters as big as possible.
Do x 3, three times per day

TIP: if you are having difficulty with any of the letters then your ankle is still probably stiff. Our physios can help you with this.

Hang on to a table/ chair to start with.
Balance on a pillow or two with 1 leg. Try to hold your balance for 30 seconds. Test yourself against your other leg

TIP: You should be able to do this for 30 seconds with both legs. You should feel stable and in control before letting go with your hands.

Wobbleboard
Our Physios may prescribe you a wobble board and other exercises to improve your strength, stability and control to prevent further injuries in the future.

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