[cs_content][cs_section parallax=”false” style=”margin: 0px;padding: 45px 0px;”][cs_row inner_container=”true” marginless_columns=”false” style=”margin: 0px auto;padding: 0px;”][cs_column fade=”false” fade_animation=”in” fade_animation_offset=”45px” fade_duration=”750″ type=”1/1″ style=”padding: 0px;”][cs_text]Introduction
Ankle injuries are commonly referred to as a sporting injury due to their high incidence rates in sports that involve jumping, twisting, sudden bursts of speed, direction change and turning movements such as basketball, volleyball, netball and football. However something as simple as walking on an uneven surface can cause a painful and debilitating ankle sprain.
The most common type of ankle injury is Ankle Sprains, where in most cases the ankle rolls inwards (inversion sprain), under the weight of the rest of the body as a consequence of jumping, landing or changing direction. This results in damage to the ligaments on the outside of the ankle, most commonly the Lateral Ligament.
Adequate rehabilitation of your ankle injury is very important to reduce the effects of persistent symptoms to the ankle and prevent the incidence of re-injury.
The ankle joint is a hinge joint, that is formed between the tibia and fibula (bones of the lower leg) and talus (bone of the foot) that allows the foot to bend upwards (dorsiflexion) and downwards (plantarflexion). The joint also allows a small amount of rotation (inversion/eversion) and it is movements outside this normal range of rotation where ankle sprain injuries occur.
The ankle joint is held together by ligaments, which act as strong elastic bands of connective tissue, which keep the bones in place while allowing normal ankle range of motion. Tendons attach the muscles to the bones to do the work of making the ankle and foot complex move and help to stabilise the joint.
With inversion ankle sprains the most common injury ligament is the Lateral Ligament, which consists of three parts:
1. Anterior Talofibular Ligament (ATFL)
2. Calcaneofibular Ligament (CFL)
3. Posterior Talofibular Ligament (PTFL)
These three ligaments work together with the peroneal muscles, which run down the outside of the calf muscles to keep the ankle joint stable. Of the three, the ATFL is the most commonly damaged ligament in inversion ankle sprains.
Injuries to the inside of the ankle resulting from the ankle rolling inwards (eversion sprain) are rare and much less common compared to the ligaments on the outside of the ankle. The inside of the ankle is held together by the:
• Deltoid Ligament, which is made up of the Anterior and Posterior Tibiotalar Ligaments and the Tibiocalcaneal ligament
• Tibialis posterior muscle
The severity of ankle sprains are classified into 3 grading’s:
Grade 1: Mild sprain, with damage to a few fibres within the ligament. Swelling and bruising in and around the injured ankle is common but should dissipate within 1-2 weeks and by 3 weeks post injury everyday movements such as walking should be pain free
Grade 2: Moderate sprain, with painful, significant but incomplete tears to the ligament fibres. Recovery period is usually 4-6 weeks before considering a return to sports drills to allow optimal strength of the new scar tissue however can depend on complexity of the injury.
Grade 3: Severe sprain and usually involves complete rupture of the ankle ligaments. Often pain is not experienced over the site of the rupture and can also involve fractures to the bones near the rupture site. Rehabilitation normally takes 6-12 weeks, however varies greatly depending on the severity and complexity of the injury.
When you sprain your ankle it is usually obvious, you start to feel your ankle roll and doesn’t correct itself causing it to fall into an extreme position. The incidence is generally painful but usually once the ankle joint cools down after the sport or activity is usually when the damage becomes more obvious. Initially it is common that the ankle joint is swollen, bruised and weight bearing is both painful and difficult.
Early rehabilitation management focuses on reduce the pain and swelling in the joint as well as restoring the normal range of movement. This can take anywhere from a few days to a few weeks depending on how bad the sprain was. This is achieved by focusing on the PRICE principle of Protection, Rest, Ice, Compression and Elevation. The earlier you do this the more likely you are to aid in the healing process.
• Protection may involve the use of crutches, to avoid painful weight bearing through the joint, or where a fracture has been detected the use of a moon boot for immobilisation is frequently used. If you experience difficulty putting any weight through the foot/ankle immediately after the injury could indicate a break. Seek further medical advice if weight bearing is very difficult and painful.
• It is important post injury to let your body and ankle joint rest, so that the body can do its job in repairing and regenerating the joint. Simple ankle movements such as flexing the ankle both forward and backwards in the early stages is beneficial to help reduce swelling and promote blood flow to the joint.
• Regular icing is recommended to assist the body in combating any swelling that may occur in the joint and reducing inflammation.
• Using compression bandages on the joint can also assist in reducing swelling to the joint.
• While inflammation and swelling of the joint is common it is important to elevate the ankle/foot throughout the day to prevent the swelling and pooling in the ankle joint.
Restoring strength back to the lower leg is the next stage of the rehabilitation process. This starts with building strength in the muscles that surround and support the ankle joint and then moving up the chain to include muscles that are important in long-term stability and return to sport such as the hips and abdominals. Exercises such as heel walking, toe walking and simple eversion exercises with the aid of a resistance band are simple but effective exercises for this stage of rehabilitation.
Proprioception and balance are two factors that are commonly compromised in ankle injuries and can be forgotten about during the rehabilitation process. Once pain and swelling is under control, it is important to retrain our awareness of where our bodies are in space by challenging balance and muscle control around the ankle, knee and hip. Balance retraining is an important part of the rehabilitation awareness as it prepares our body for a return to sport and also aids in reducing the risk of a recurrent injury by improving reaction time to unexpected movements and unstable surfaces. Once the ankle is strong and pain free standing on a balance board, a cushion or uneven surface with one leg and adding ball throwing and challenging balance with your eyes closed can help retrain proprioception.
Finally exercises that are specific to your chosen sport such as jumping, landing, and change of direction are incorporated to prepare the individual for a return to sport.
It is important to remember that each ankle injury and individual is different, therefore it is hard to always give an accurate timeframe for recovery and return to sport. Factors such as swelling management, previous history, strength and stability of the ankle joint and surrounding muscles and the severity of the injury will ultimately dictate the recovery and return to sport timeframes.
Even after your return to sport, it is important to continue to perform your specific ankle rehabilitation program long term to continue to keep your ankle strong and help to minimise the risk of re-injury.
Ankle sprains can be both frustrating and annoying injuries but if they are dealt with correctly you can reduce the chances of re-injury and return to sport and every day activity without concern. It is important you rest immediately post injury to allow your body to do its thing and to have your injury properly assed in order to achieve the best outcomes from your rehabilitation.
Contact the RAD team so we can assist you along the right track with your ankle sprain by providing an individually tailored and specific rehabilitation program based on your needs to get you back on your feet playing sport or running around the park with your kids as soon as possible.