In this episode of the Morley Physiotherapy Centre Podcast, Tony talks all about ankle sprains – how they happen, when to see a doctor, and how to achieve the best possible recovery.
Ever had an ankle sprain? Worried you might get one? Do you play a sport that involves running, jumping, and changing direction quickly? This episode about ankle sprains is for you. Sit with physiotherapist Tony Pullela as he explains ankle sprains: How they’re caused, what the symptoms are, what to do if you get a sprain, when to see a doctor, and how to achieve the most full and complete recovery possible.
The full transcript is below!
If you’ve ever had an ankle-sprain before or have one right now, this information may seem very important and relevant to you now. But you never know, you might need the information in the future so bend an ear and let’s see what we can come up with.
First of all, ankle-sprains are very common in multidirectional sports and the evidence suggests that ankle-sprains account for approximately 25% of all sport injuries. That’s a pretty big amount. And in fact, one sprain occurs in every ten thousand people, every day.
This isn’t the only finding I was amazed at. The most alarming finding is that up to 40% of sprains can become ongoing problems. And this indicates to me that after an ankle-sprain, the natural recovery is not always consistent and reliable and that means it doesn’t always get better over time. And the second thing it reminds me of is that it’s important to get specific advice and early injury assessment to improve long term recovery.
How are Ankle Sprains Caused?
Obviously, the foot is twisted suddenly under load and as it’s twisted, it causes an overstretching of the ligaments on the outside of your ankle. Now, in case you haven’t studied anatomy before, ligaments are part of the soft-tissue of the body, they are stabilisers and they connect bone to bone. So they’re very important for keeping the joint stable. If the ligaments are overstretched, you can get different degrees of injury, ranging from micro-tears, partial-tears, and complete ruptures. Later on I’ll discuss with you some of the time-frames that are required to recover from these types of injuries.
But when it comes to getting an injury like this, what do we experience?
Well I suppose the first thing we experience is intense symptoms and we also experience a degree of functional loss. So what does intense symptoms mean? When you tear or stretch a ligament, it causes damage, bleeding and inflammation and that causes sensitization of all the nerve-endings in that area.
What do we feel?
We feel pain and it’s localised to the outside of the ankle. We have swelling and bruising and obviously, as we have pain and swelling, we’re unable to load the foot, walk and stand or move the foot and ankle.
So what should we do once an ankle-injury occurs?
First of all, apply first aid. And it’s immediate. Injury management is very important in the first 12 to 24 hours and long-term recoveries are improved if the protocols for first aid are put into place early.
The first aid protocol is called R.I.C.E or rice.
Most people are familiar with this but I’m gonna go through it anyway, just to remind you. First of all, R stands for rest. We have to relieve the load and the weight has to be relieved to improve pain. Obviously, crutches and bracing are some of the things we use in this stage. The main thing to remember is, we want to protect the joint and support it to prevent further injury. It doesn’t mean avoiding all movement, all it means is we should encourage pain-free movement and function that we have. The second part of the protocol is I for ice. We should be applying ice-packs to the area for 15 minutes every two hours for the first 12 to 14 hours. Ice is helpful because it minimises the bleeding and inflammation process that occurs after the injury. And also, it’s an effective pain reliever because it numbs the area. Please remember to avoid burning the skin with an ice-pack and apply a wet towel right between the skin and the pack. The C or the compression part of the protocol is very important, as one of the important ways to reduce the swelling and improve inflammation. And applying bandages and appropriate taping is an effective way to apply compression. The final part of the protocol is E for elevation. Elevating the limb above the head will assist in the drainage of fluids and swelling away from the ankle.
So once we’ve applied the R.I.C.E protocol, we know we’re doing the best thing for our injury.
But when is it necessary to see a doctor or a physiotherapist?
The need for immediate assessment by a doctor or a physiotherapist will depend exactly on how bad the injury feels. In severe cases, where load can’t be taken at all, we should suspect the possibility of a bone fracture. And if this is the case, your health-professional can organise an x-ray and this can establish whether any bone damage has occurred. If the x-ray is negative, we know it’s a soft-tissue injury and therefore the physiotherapist is the best person to see to help you recover, to assess your injury and also to help you understand what is the appropriate treatment and time-frame of recovery.
What are the different types of ligament damage?
The first one or grade one is less than 25% tearing and the time-frame for recovery here is good, one to two weeks. If we have a grade two injury that means we have a 25 to 50% ligament damage or tear and we have a time-frame of recovery of up to four weeks. And if we have a grade three injury, we can have up to a six week recovery. And if we have a total ligament rupture, that’s a more difficult one to establish a time-frame for, but 12 weeks is a minimum and an orthopaedic surgeon may be required to consult with in case surgery is needed to functionally stabilise the ligament.
How to achieve the best possible recovery from ankle sprains?
Appropriate rehabilitation is essential for long-term recovery after ankle-sprains.
At Morley Physiotherapy Centre, our rehabilitation model is based on my 35 years of physiotherapy practise, and also based on the up-to-date research and evidence that we have on hand to help us design our specific treatment and exercise programmes.
First stage rehabilitation requires help to improve pain and inflammation, and once that stage is achieved, we can move on to mobilisation and recovery of movement and flexibility in our second stage. But I think the most important one to achieve is our third stage of rehabilitation which is often missed out in people who don’t have the physiotherapy treatment. This requires functional retraining to recover the full strength and loading capacity of the leg and also to help improve the balance and stability mechanisms that help us tolerate returning to sport.
If we can develop balance, stability, and coordination to allow us to form the movement patterns required for specific sports, to be retrained, we’ll be able to return to jumping, landing, and changing of direction, and recovering all of the motor skills that are needed to avoid future re-sprains and ongoing instability that I mentioned before, in the 40% that have ongoing problems.
So I hope this information helps you understand what you can do in the first stage of treatment, and also when to know to get appropriate assessment and diagnosis from your health professional. If you’re needing any further advice, at Morley physiotherapy we’re only a phone call away. I hope that you feel well, move well, and live well.
All the best!
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