Should I see a Physio for My Ankle Sprain?

winter sports injuries

Ankle sprains are a common injury.

Common in active people.

Common in clumsy people.

And those who need to regularly traverse uneven surfaces, a bit like some of the sidewalks around Balmain and Rozelle.

Most clients I meet in the clinic have had at least one ankle sprain. And some several over the years. Often related to sport. Sometimes due to general hypermobility.

Ankle sprains are very common in those who have played a lot of netball, basketball or soccer.

People often think of ankle sprains as a minor and isolated injury.

However as a ConnectTherapy™ trained physiotherapist I see firsthand how an ankle injury can impact other areas of the body – the knee, hip, pelvis, thorax, neck and shoulders. It is through the compensations of the body in which an ankle sprain can have ramifications down the line.

As such I believe that it is always important to seek out physiotherapy care for an ankle sprain.

What exactly is an ankle sprain?

An ankle sprain is when you stretch your ankle ligaments beyond their capacity.

Unlike tendons (which attach muscles to bones) which are quite elastic, ligaments (which attach bones to bones) are relatively more “plastic” due in large part to the organization and type of collagen they are composed of.

The most common mechanism for spraining one’s ankle is when the ankle “rolls” into plantarflexion and inversion – in essence a “rolled ankle”.

I am often surprised when people tell me that they have never sprained their ankle, but that they have rolled it more times than they can count.

A sprained ankle = a rolled ankle.

They are one and the same.

Moving beyond the semantics of it, a rolled ankle is likely just a grade 1 ankle sprain and heals quite quickly as opposed to a “sprained ankle” which may take weeks to months to recover.

Four-men-playing-basketball

Are there different types of ankle sprains?

Yes. There are two key types of ankle sprain.

They are based on the mechanism of injury and which ankle ligaments are injured.

Inversion Ankle Sprain

This is the most common type of ankle sprain, in which you “roll” your ankle into plantar flexion and inversion or roll out onto the side of your ankle with your toes rolling inward. This overstretches and tears the lateral ankle ligaments.

Eversion Ankle Sprain

Not as common and the inversion sprain. Occurs when you roll inward on your ankle with your foot turning outward, stretching and tearing the medial ankle ligaments.
winter sports injuries

How do you sprain your ankle?

An ankle sprain is a biomechanical injury that often results from:

  • A misstep onto the foot (e.g. curbs, steps, jumping)
  • A fall where the ankle twists
  • Walking/running on uneven ground

For those who have recurrent ankle sprains, it is often due to:

  • Lack of recovery from a previous ankle sprain
  • Poorly fitted footwear
  • Hypermobility

What are the signs and symptoms of an ankle sprain?

  • You may have heard a “pop” at the time of injury
  • Swelling around the site of the injury or the whole ankle in more severe sprains
  • Bruising and tenderness
  • Loss of range of motion of the foot and ankle
  • Difficulty weight bearing
It is important to note that an ankle fracture can present similarly to an ankle sprain, so it is important to seek medical attention (Emergency), particularly when there is pain or limitation to your weight bearing ability.

Ankle sprains are further classified based on the degree of injury to the ankle ligaments.

Ankle sprains are classified as grade 1, 2 or 3.

Grade 1 Ankle Sprains

A minor injury to one or more of the ankle ligaments with no tearing. There is no significant disability. Minimal swelling. Walking may be tender. Generally takes 2 to 3 weeks to recover.

Grade 2 Ankle Sprain

A moderate injury resulting from a partial tear to one or more of the ankle ligaments resulting in more discomfort. Activities of daily living such as walking and stair climbing will be more limited. Generally takes 3 to 6 weeks to recover.

Grade 3 Ankle Sprain

A more severe injury where there has been a complete tear of one or more of the ankle ligaments, resulting in a lot of discomfort and pain. This injury may take 3 months to recover.

 

Depending on a variety of factors – mechanism, grade of injury, etc, other soft tissues may be injured as well – including muscles and tendons around the foot and ankle. This can result in more swelling, pain and immobility.

Most ankle sprains are relatively uncomplicated and heal well. But as postulated with the title of this week’s blog…

Physio-measuring-ROM-of-an-ankle-sprain

Do you need physiotherapy for your ankle sprain?

The simple answer is yes. But really it depends on the case and the individual.

When in doubt, go see your Physiotherapist to get the all clear.

For a grade 1 ankle sprain that heal over a couple of weeks, it may not be necessary, but if you are an active individual it would be good to ensure your ankle sprain isn’t resulting in other compensations – especially important if you are dealing with any other body aches, pains or niggles.

For grade 2 and 3 ankle sprains, without a doubt you should get your ankle assessed. 

A Physiotherapist may refer you for scans to rule out a fracture. Using manual techniques, exercise and education, they can assist your recovery – regaining mobility, rebuilding strength, restoring balance and proprioception and return to exercise and sport.

Why is it so important?

An ankle that is swollen, stiff and painful can result in a lot of other body compensations:

A weight shift onto the other side of your body.

This will result in your unaffected side working that much harder.

And the muscles of your affected knee, hip, and back work less due to less stimulation.

The longer you go on with left-right body imbalances the more this may perpetuate local pain, stiffness and swelling in your ankle. And may lead to issues elsewhere.

Physio mobilising an ankle sprain

What can physiotherapy do to help your ankle sprain?

For your typical grade 2 ankle sprain we would take you through the 3 key stages of rehabilitation as your ankle injury heals.
Physio wrapping bandage around mans ankle spain

Acute/inflammatory stage - first 3 days

In the first few days of your injury your ankle may be swollen, bruised and tender to touch, and struggle to bear weight. At this stage, the main goal is to assist with the injury process.

Swelling is a necessary part of the injury process and there is some debate on whether or not to ice to decrease swelling. In any event, ice can be used for pain management. The use of NSAIDs or anti-inflammatories is not recommended, however analgesics can be used for pain. The reason behind this is we want to support the natural inflammatory response to tissue injury. Taking NSAIDs (and ice) may limit this process.

The key principle recommended here is PRICE.

PRICE = Protection. Rest. Ice. Compression. Elevation.

Protection. Brace or bandage to limit motion and therefore stress on the injured ligaments, depending on the severity of the sprain.

Rest. Relative rest that is. Not bed rest. You will just need to limit activity that requires loading the affected ankle. So any exercise using your upper body or unaffected leg is fine. Other low impact exercises such as swimming or cycling are recommended.

Ice. Initially used for pain management and to prevent excessive swelling. Apply for 10-20 minutes every 2 hours over the first 3 days.

Compression. Helps to reduce and manage swelling. Compass with bandages or taping. Not too tight to prevent blood flow which is essential for assisting in the healing process.

Elevation. Elevate the foot above heart level. Due to decreased mobility, swelling may further increase. Elevating the affected foot will assist in managing swelling.

Alongside this, your physiotherapist may recommend:

  • Ankle range of motion exercises
  • Ankle pumping to promote blood flow/circulation
  • Gentle weight bearing
  • Use of crutches or a brace
Physoop instructing band exercise to strengthen ankle

Subacute/Scar tissue Formation stage - day 4-10

In this stage it is time to get moving and loading the ankle to stimulate new collagen and promote the formation of strong scar tissue. Here as your physiotherapist we will give you exercises to improve your:
  • Range of motion
  • Mobility
  • Balance
  • Coordination
With exercises including:
  • Drawing the alphabet with your ankle
  • Ankle circles
  • Stretches for your calf and hamstrings
  • Dorsiflexion mobility on a step
  • Single leg balance
  • Toe curls for the muscles of your feet
  • Bridging and/or clamshells for your glutes
Two people performing lunges in the gym with weights

Remodeling/Rehabilitation stage - day 11-21

Now it’s time to promote a return to activity and as such your rehabilitation will be progressed to ensure:

  • You restore full mobility of the foot and ankle
  • You rebuild your muscle strength
  • You regain ankle stability for everyday activities
  • You return to activities such as walking, stairs, hills with sufficient balance and coordination

Exercises may include:

  • Squats
  • Standing heel raises
  • Eccentric heel raises
  • Single leg heel raises
  • Toe and heel walking
  • Lunging, forwards, backwards, sideways
  • Jumping – two legs, one leg

At RedoHealth we really enjoy treating ankle sprains. Most ankle sprains we see heal well with no complications.

Putting on our ConnectTherapy lenses also allows us to see how your ankle injury impacts the rest of your body and by ensuring a restoration of ankle mobility and function we can help ensure a return to doing the things you love.

For those with ankle injuries that persist, with poor mobility and pain, it is often through addressing other areas (such as your thorax, the area that often does the most compensating) that we can assist you in achieving your maximum recovery.

Book an assessment to get your ankle assessed here.

Nighttime volleyball match

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