One of the most commonly injured joints in the body is the ankle. A lateral ankle sprain, twisted ankle, rolled ankle and inversion sprain are all synonyms for the same, common injury. Females are at a greater risk than males for sustaining an ankle sprain, and children are at a greater risk than adults.
What happens? The anatomy of the ankle is such that it is physiologically most susceptible towards the lateral edge of the mortise joint. The Tibia, Fibula, Talus and Calcaneus are held together by ligamentous structures deep to the surrounding musculature. This lateral edge has a good amount of mobility, allowing for locomotion; however, what we gain in mobility, we lose in stability. Therefore, most mobile part of the ankle is also the most susceptible to injury.
The anterior talofibular ligament is the most commonly injured ligament during an ankle sprain. This is followed by the calcaneofibular ligament, and the posterior talofibular ligaments when the sprain is more severe.
Do you need imaging? Most often, no. However, it is good to have it assessed and diagnosed by a healthcare professional such as Dr. Bulman. The ottawa ankle rules determine if your ankle needs an X-ray or other more advanced imaging.
Ankle sprains swell up quickly. The principles of Rest, Ice, Compression and Elevation (RICE) have been the mainstay of early treatment for many years. However, some have questioned if this is the best evidence based treatment. The newer principle of Protect, Optimal Loading, Ice, Compression and Elevation (POLICE) has been suggested by the British Journal of Sports Medicine as a potential replacement to first line treatment. However, this is still an evolving field of research.
Treatment early can help you recover more quickly; furthermore, aggressive rehabilitation can help minimise your time away from sport, and help decrease the likelihood of a future injury. Unfortunately, once an ankle sprain occurs...like most other injuries, the chances of recurrence are much higher than if the injury had never occurred.
Many rock climbers and boulderers, who we see a lot of at sports n spine, have a history of ankle sprains. Common mechanisms include falling from a boulder problem and landing with direct force upon one's heel; or landing asymmetrically on the ankles. Some studies suspect that even in rock climbing, up to 50% of rock climbing injuries are to the lower limb. These injuries are sometimes slightly more problematic, and include syndesmotic sprains (high ankle sprains) and talar dome injuries. The outcomes for this type of injury are different from your average lateral ankle sprain and often times need different management.
Early on in your treatment, we might strap your ankle to reduce swelling, and assess you for activity modification. After ruling out fracture, it is usually ok to begin walking on the limb as soon as one can bear weight. This will speed up your recovery, and is part of the optimal loading strategy. However, this is determined by you and your doctor and is done on a case by case basis.
Early restoration of the range of motion is helpful. Post-isometric relaxation exercises can be useful, as can ankle joint adjustments and calcaneal mobilization to promote healthy scar tissue. After the initial inflammation has settled, exercises can commence.
These can and should be progressed to more neurodynamic stabilisation exercises to prevent recurrence of injury. You should be guided by a healthcare professional though these exercises so that they are progressed in an appropriate time frame. The key to injury management is appropriate loading.
For more information, call 8540 4955 or book an appointment online through Sports N Spine.