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Ankle Sprains - What are they? How are they managed?

Ankle Sprains - what are they?

Last week, I knew it was winter sports trials time – how? The number of ankle sprains I was treating.  At Hillcrest Physio we have several school clinics and this time every year we have a big spike in ankle sprains that we are treating.  On Friday 70% of my cases were ankle sprains, ranging from very mild to a full rupture. 

So, what is an ankle sprain?  The most common injury presenting as an ankle sprain is an injury to the ligaments on the outside of the ankle (a lateral ankle sprain).  There are 3 main ligaments here, and the most commonly injured is the AFTL. Ligaments connect bone to bone and provide stability to a joint. 

We grade these injuries from a 1 to 3, 1 is mild and 3 is a full rupture. 

Less commonly we see injuries to the inside or medial ankle, these can involve the big Deltoid ligament.  Ankle sprains may involve the tendons around the ankle and also the joint cartilage and sometimes small fractures.  In adolescents and younger people, we need to be aware of growth plate involvement.

With the number of structures and variations in severity, ankle sprains may settle in days or take months.  Mostly they can be managed conservatively, but sometimes other intervention such as injections of various types or surgery may be necessary.

So how do we treat an ankle sprain?

As mentioned in a previous blog we use PEACE and LOVE

Initially you may be put in a moonboot for a few days to settle the pain and swelling and protect the ligament, it is then important to get moving. 

Ankle sprains have a high recurrence rate especially in the first year, up to 20% or more.  So, rebuilding the muscle strength and stability of the ankle is really important.  This is done with graded exercises.  You may be recommended to wear an ankle brace or tape for the season.  This will not make the ankle weak but adds an extra layer of protection while the brain and muscles get back to full power.

What can you do to prevent sprains in the first place?  There is not a lot of consensus on this, most research is inconclusive.  But we do know that programmes like the FIFA 11 football warm-up and the NZ Netball Smart programmes have been shown to reduce injury.  They involve practising movements including jumping/landing and sideways movements to engage the brain and muscles before the game.  Warm-up should always occur to get muscles and the brain ready for action, and incorporating landing skills and strength, agility and flexibility work into training will help reduce the chance of injury.   We tend to see a large number of ankle sprains at preseason trials because people are not “match fit”.  If you know you have trials coming up, start doing some training and build up slowly.

Conclusion

In conclusion, ankle sprains are one of the most common injuries we see. They can be relatively simple through to quite complex injuries involving multiple structures.  Time frames for return to activity vary widely, but most can be treated with physiotherapy and appropriate rehabilitation.  Some may require further intervention.  Recurrence rate is high, and treatment is aimed at reducing this.  Appropriate training in strength, agility, and flexibility along with sport specific drills and landing skills can be important in reducing the incidence.  Strapping and bracing have been shown to be useful in reducing recurrence. 

If you have an ankle sprain, physiotherapy is important to get you back to function safely and reduce the chances of doing it again.



 

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