It can happen at any time…while playing sports, stepping off a curb, walking in high heels…and it can happen to anybody…athletes, non-athletes, adults, children… you twist your ankle. Recent statistics show that on any given day, more than 25,000 individuals in the US will sprain their ankle. What exactly is an ankle sprain, and how should we proceed with diagnosis and treatment?
WHAT IS AN ANKLE SPRAIN?
A sprain is an injury to a ligament. Ligaments go from bone-to-bone and provide stability to our joints. So when our foot/ankle twists beyond its normal range of movement, and ligaments are torn, partially torn, or stretched beyond their normal length, an ankle sprain results.
Ankle sprains are given a Grade from 1 to 3, based on how badly the ligament is damaged or if multiple ligaments are involved. A Grade 1 sprain would be classified as mild, Grade 2 would be classified as moderate, and Grade 3 would be classified as severe. In addition, ankle sprains are also classified as acute, chronic, or recurrent.
An acute sprain occurred recently…usually within the past several weeks…and is in an active stage of healing.
A chronic sprain continues to be symptomatic well beyond the normal time of expected healing.
A recurrent sprain is one that occurs easily and frequently, often with very minimal force. This would be equivalent to re-spraining your ankle.
WHAT ARE THE SYMPTOMS OF A SPRAINED ANKLE?
When we typically think of an acute ankle sprain, we generally think of 3 characteristics: Pain, Swelling, and the Inability to bear weight on the ankle. With most ankle sprains, pain is usually instantaneous at the site of the ligament damage, and in most cases the ankle immediately begins to swell. You may or may not notice bruising over the next 24-72 hours. You will also generally experience pain to the touch, as well as discomfort with movement of the ankle. In severe ankle sprains you may actually hear or feel a “pop” or a “snap.” In most cases, the more pain you experience the more severe your ankle sprain, and the longer the healing process will take.
DO I NEED A DOCTOR?
In the majority of cases, a Physical Therapist can perform a thorough, comprehensive evaluation of your foot/ankle. Manual tests can determine the degree of instability of your ankle. At that time, the Physical Therapist can then make a recommendation if he/she feels that diagnostic tests are indicated or you would need a consultation with an orthopedic surgeon. In some cases, X-rays may be indicated if the mechanism of injury suggests a possible fracture. Also, with severe ankle sprains, a MRI is often needed to determine the extent of the damage.
HOW CAN PHYSICAL THERAPY HELP IF I HAVE A SPRAINED ANKLE?
Within the first 24-48 hours after an ankle sprain, we generally adhere to the RICE principle…Rest, Ice, Compression, Elevation. Your Physical Therapist can instruct you in a specific treatment program for you to adhere to at home to help speed your recovery, along with advice on whether you should be using an assistive device (walker, crutches, or cane) to protect your ankle while it is healing. The overall goal of Physical Therapy is to return you to your prior level of function in terms of activities you perform at home, at work, and in the community. Without proper rehabilitation and skilled care, serious problems could arise. These could include chronic pain, swelling, decreased movement, and joint instability, all limiting your ability to perform your usual activities. Treatments most likely would include:
Range of Motion/Mobility Exercises–Pain and inflammation can cause limited mobility of your ankle. Your Physical Therapist would instruct you in safe and effective exercises to restore full mobility to your ankle.
Muscle Strengthening Exercises–Weakness in your ankles can lead to long-term instability, which could give rise to new ankle injuries. Your Physical Therapist would instruct you in the proper strengthening exercises based on the severity of your injury and where you are in your recovery.
Body Awareness and Balance Training–When you are able to put full body weight on your foot/ankle without pain, your Physical Therapist may prescribe specialized training exercises to help your muscles “learn” to respond to changes in the environment, such as walking on unstable or uneven surfaces. A normal progression would be to start with eyes open, then progress to eyes closed, standing unilaterally on the involved leg, then advancing to a Wobble board to challenge the muscles of your ankle and lower leg.
Functional Training–When you are pain free, your Physical Therapist may begin progressing your treatment to include activities such as walking in your neighborhood, jogging, hopping, or modified running. This will be based on your Physical Therapist’s objective findings of your ankle, your personal goals, your overall activity level, and your general health.
Activity-Specific Training–Depending on your particular situation, your rehab may now focus on return to sport or return to work activities, taking into account the specific demands that would be required for your ankle.
CAN ANKLE SPRAINS BE PREVENTED?
Accidents happen, and are sometimes unavoidable. But certain risk factors can give you an overall picture of how likely you are to suffer a sprained ankle. First and foremost is past history…if you have sprained your ankle in the past you will be most at risk for re-spraining that same ankle in the future, especially if the ligaments did not heal properly or if you never regained full strength in that ankle. Also, if you return to sports or activity too soon after injury, your ankle may give you persistent pain and be prone to rein jury. This is why it is so important to get the proper professional advice from a Physical Therapist to determine when you are ready to return to your sports or activities by making sure your ankle is strong enough and flexible enough to withstand the rigors needed to be placed upon it. Any muscle imbalances can be addressed and corrected by combining the proper flexibility and strengthening exercises as well as functional training to allow you to gradually and safely return to your activities without injury.
If you or someone you know is experiencing ankle pain from a sprained ankle, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t delay–schedule now!