Most ankle sprains occur with excessive rolling in of the foot causing the ligaments on the outside of the ankle to be over-stressed, torn or even ruptured. This commonly happens when players change direction quickly or land from a height (taking a mark). Landing on an uneven surface or another player’s foot (more common than you think), can produce the same result.
When the ligament complex on the outside of the ankle (known as the lateral ligament) is strained or torn, its’ fibres bleed into the surrounding tissues. The result is an ankle that is painful and often grossly swollen. Treatment within the first 48 hours is vital to the effective management of all soft tissue injuries, including ankle sprains.
When initiated immediately following the injury R.I.C.E.D. treatment can help control inflammation, reduce swelling, relieve pain and speed up the healing process after sprains, strains, muscle bruises (corks), bumps, bruises and many other injuries.
R Rest – Cease aggravating activity immediately. Continued stress to the injured area can prolong the injury and extend time off the field.
I Ice – A quick application of ice to the affected area helps reduce inflammation, swelling and bleeding. The safest way to apply ice is over a damp towel. Ice can be applied for 15-20 minutes every 2-3 hours in the first 48 hours of injury.
C Compression – Of the injured area helps to decrease inflammation and swelling and provide support to the injured area. A firm but not tight bandage should be applied between ice treatments and can be used during the first 48-72 hours.
E Elevation – Of the injured area will again help control inflammation and swelling. It is important that the injured area is above the level of the heart. Decreasing inflammation and swelling helps to decrease pain.
D Diagnosis – An accurate diagnosis is essential for an optimal and early recovery. Assessment determines the exact nature of the injury and helps determine further physiotherapy treatment and rehabilitation.
Your physiotherapist will check the entire foot and ankle complex. Commonly ankle sprains involve not only a strained or torn lateral ligament, but also damage to the inside aspect of the joint, as this is subjected to heavy compressive forces during the injury. Pain may also extend down into the foot as players often sprain some of the many joints and ligaments in the foot as well as the ankle itself. Occasionally, a small piece of bone is torn off the outside of the ankle as the ligament is ruptured. Should this be suspected, your physiotherapist will send you for a check X-Ray.
Physiotherapy treatment for an acute ankle sprain should commence as soon as possible after the injury. Time taken to return to sport will be dramatically shortened with the use of electrotherapy modalities, such as ultrasound and interferential, to reduce pain and swelling and maximise healing. Hands-on techniques and exercises are used to promote early, good quality tissue repair and prevent joint stiffness.
As the majority of the balance receptors for the lower limb are contained in the ankle lateral ligament, graded proprioceptive or balance drills are vital to bring these back up to speed. Failure to perform these will result in a ‘clumsy’ joint with the player likely to re-sprain easily. Most players who complain of ‘weak’ ankles in fact have ‘clumsy’ ankles due to lack of balance training to switch these receptors back on.