Ankle sprains are a very common injury that many of us have experienced at some point in lives. The injury itself is usually caused by trauma to the ankle through overturning or twisting of the ankle which can result in pain and injury. The severity of this depends on the level of trauma and the amount of damage caused to the structure. Very mild sprains can manifest with just a little pain and minimal inflammation allowing the person to continue their activity. More sever sprains can be extremely painful, difficult to weight bear and sometimes require hospital treatment.
Symptoms of an Ankle Sprain
One of the main tell-tale signs of an ankle sprain is how it occurred. If the injury occurred through trauma to the ankle, causing a twist or rotation to the joint there is likely to be an injured structure.
Symptoms of an ankle sprain typically include:
- Swelling and/or bruising.
- Pain to weight bear.
- Pain directly over the ankle (usually on the outside edge).
- Redness or heat around the joint.
- Restricted movement.
- A pop noise or sensation at the occurrence of the injury.
So What is Causing the Pain?
The ankle joint itself is a synovial hinge joint and is made up of three bones; the Tibia, the Fibula, and the Talus. Its primary movements are plantarflexion and dorsiflexion (pointing the foot down and up). The ankle joint gains its stability from ligaments crossing the joint on both the inside edge (deltoid ligament) and outside edge (anterior and posterior talofibular ligament, and calcaneofibular ligament).
Inversion Ankle Sprain
The majority of ankle sprains occur in an inversion movement, (see diagram) this places load on anterior talofibular and calcaneofibular ligaments. These two ligaments are the most commonly affected ligaments in an ankle sprain.
Eversion Ankle Sprain
This type of sprain is less common and occurs on when the ankle twists inwards and the foot twists outwards. This places load on the deltoid ligament on the inner aspect of the ankle. The ankle is well supported against this movement so a sprain to this ligament usually involves high force and often injury to the bone and other ligaments. Pain with this injury is on the inside area of the ankle with pain likely in other affected areas of the ankle.
High Ankle Sprain
This type of sprain is the rarest of ankle sprains and involves injury to either the posterior or anterior inferior tibiofibular ligament (ligaments joining both Tibia and Fibula bones). These ligaments are located above the ankle, hence the name high ankle sprain, and play an important role in ankle stability.
Severity of your Sprain
It’s wise to have your sprain assessed so you can get the right advice and management, and to be sure that there isn’t an underling fracture. Sprains are generally categorised into grades indicating their severity (see image):
- Grade 1 Sprain – Stretching of the ligament with possible mild tearing, causing pain and inflammation. The ankle’s stability is usually intact and weight bearing is possible.
- Grade 2 Sprain – Moderate tearing to the ligament but still intact, causing pain and inflammation. Can also show signs of decreased stability and can be painful under weight-bearing.
- Grade 3 Sprain – Complete rupturing of the ligament with pain and inflammation. Ankle feels unstable and weight-bearing is usually not possible.
Ankle Sprain Recovery
As one may expect the recovery times for an ankle sprain are dependent upon the severity/grade of the sprain. A persons health and own self-help also impact the recovery.
Although it is wise to have your ankle assessed to determine the level of injury, initial advice P.R.I.C.E is generally safe and beneficial in the initial period after injury.
- Protection – Protect the area from further re-injury.
- Rest – Rest the ankle, allowing the ankle to heal without re-aggravation
- Ice – Cool the inflamed area to decrease local inflammation and promote healing. Ice for up to 10 minutes every two to three hours, with ice pack wrapped in tea towel.
- Compression – Use compression bandage to limit swelling.
- Elevation – Keep the ankle elevated to limit swelling.
PRICE advice focuses on working with your body’s inflammatory response by limiting inflammation and is considered sound first aid advice.
Intervention and Rehabilitation Stage
Research in this area has highlighted good support for early intervention and rehabilitation in the recovery of ligament injuries. However, this will depend on the degree of injury and your bodies recovery rate. Movement and exercises can be introduced to help your body naturally repair and strengthen the injured ligament.
After a ligament injury, changes in the ligament’s stretch receptors can occur causing a change in your body’s positional sense for that joint. This sense is actually part of your body’s neurological system and is called proprioception. If you have sprained an ankle in the past, you may have noticed that you’re more likely to go over the same ankle again, this could be due to proprioceptive changes in the joint, or instability in the ligaments.
Balance exercises can be introduced to help retrain your body’s proprioceptive ability and help strengthen the joint under stress. Long-term, this will aid full recovery and help prevent a re-occurrence in the future.