Ankle Sprain

Posted by Brendan Hill G.S.R on Wednesday, July 23, 2014

Last week we had a look at shin splints, which, judging by the feedback, is something that a lot of people have suffered from and/or continue to suffer from. I had a few runners into the clinic this week and they asked me to do a piece on ankle sprains. You don’t have to be very active to have had one of these as we have all ‘gone over’ on our ankle at some point in time.

When we say ‘gone over’ we are usually referring to having injured the outside of the ankle, this is called a lateral ligament injury or an Inversion sprain. Eversion and syndesmotic sprains may also occur but we will deal with them in a future article. The usual mechanism of injury is inversion and planterflexion, which is basically rolling over on your ankle while you are attempting to walk/run. As you can see from the picture, there are 3 ligaments on the lateral side of the ankle; ATFL, CFL and PTFL. The ATFL is usually damaged before CFL as the ATFL is tight when downward pressure is being applied by the foot. The greater the inversion force applied the more likely it is that the CFL and PTFL will be injured. 

In some cases there is an audible crack, snap or tear which may not be as worrying as it sounds. Depending on the severity you may continue on or may have to rest immediately. Swelling may rapidly appear in the region but occasionally it may take a number of hours. On examination the extent of the injury can be determined and categorised as a Grade I, II or III type tear. Grade I; no abnormal ligament looseness. Grade II; some degree of looseness but have a firm end point. Grade III; abnormal looseness without a distinguishable end point. All 3 Grades are associated with pain and tenderness. In Grade III cases where conservative treatment is unsuccessful surgical reconstruction of the ligament may be required. 

Initial management of the injury requires RICE treatment; Rest, Ice, Compression and Elevation. This is important as limiting the amount of swelling in the area will decrease the potential for irritation of other structures and decrease the loss of joint range of movement. Hot showers, heat rubs, and excessive weight bearing should be avoided in the first few days. Initial work should be concentrated on restoring full range of motion to the area. Muscle conditioning will help strengthen the muscles in the area so as to help avoid reoccurrence. Proprioception exercises are important as the body’s awareness of where the foot is positioned will have become impaired following injury to the ligaments. For those involved in sport, functional exercises can be prescribed when the athlete is pain free, has full range of motion and adequate muscle strength and proprioception. Taping of the ankle is advisable if playing sport but over time you should aim to not have it strapped if possible. 

Approximately 75% of people who sustain an ankle ligament injury will have had a previous injury. This is down to the fact that people usually just rest the ankle and resume playing without carrying out a rehabilitation program. If you don’t do something to strengthen up key areas of potential weakness the likelihood is that you will injure yourself again.

Tags: ankle sprain 

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Brendan Hill G.S.R. Brendan Hill G.S.R. @ Ennis Injury Clinic

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