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Ankle Pain Rehabilitation London:
Sprained Ankles
A sprain occurs when the ligaments, which join bones together, are over
stretched and damaged. An ankle sprain can occur on the inside or the outside
ligaments of the foot. The most common injury affects the outside ligaments,
particularly the anterior talofibular ligament.
A bit of Anatomy
Sprains may occur in any ligament
in the ankle, but most sprains
involve the lateral ligament
complex
the group of ligaments
on the outside of the ankle. These
ligaments are named for their
location and the bones to which
they are attached:
a) the anterior talofibular ligament
(front)
b) the posterior talofibular
ligament (back)
c) the calcaneofibular ligament
(middle).
Mechanism of Injury
Sprained ankles usually occur whilst participating in activities involving rapid
changes in direction, especially on uneven surfaces. This commonly happens on
the sporting field in association with feinting and turning manoeuvres. They are
also seen when contact with another competitor's feet causes imbalance in
landing, as may occur during a lineout or whilst playing basketball or netball.
The most common mechanism for a lateral ligament sprain occurs when the foot
turns in, underneath the body.
The first sign that you have sprained your ankle is pain. If there has been tissue
damage there will also be swelling. The degree of swelling and bruising can be
an indication of how badly the ankle has been sprained. Muscles and nerves lie
close to the ligaments and may also be damaged.
Grading of Injury
Ankle sprains are graded as 1, 2, or 3, depending on the extent of the injury.
The ATFL is the first ligament damaged, followed by the CFL and finally the
PTFL.
Symptoms and Signs include:
Grade 1 (Mild)
· Stretching or perhaps small partial tearing of the ligament complex
· Little or no joint instability.
· Mild pain or tenderness
· Little swelling
· Minimal functional loss
· Some joint stiffness.
Grade 2 (Moderate)
· Partial tearing of the ligament fibres
· Mild or Moderate instability of the joint
· Moderate to severe pain and tenderness
· Moderate swelling
· Decreased joint range of motion and stiffness
Grade III (Severe)
· Total rupture of a ligament
· Gross instability of the joint often accompanied by abnormal movement of
the ankle
· Severe pain and tenderness
· Severe swelling and bleeding
Self Help
You may have heard of RICE. Following these guidelines will help speed up your
recovery and reduce the risk of further injury.
Rest does not mean doing nothing or keeping the ankle still. It
means avoiding activities which increase pain in the ankle. You
should rest like this for one to five days depending on the severity
of the sprain. Some sprains may also require the use of crutches for
a period of time to ensure walking is symmetrical.
Ice is used to limit tissue damage by reducing the body’s
metabolism and tissue bleeding. It may also help reduce pain. Ice
should be wrapped in a damp towel, to protect the skin from an ice
burn, and applied for 2030
minutes every 2 hours. Check regularly
to see if the skin has turned bright pink or red as this is the sign of
an ice burn. If there is discolouration of the skin then remove the
ice.
Compression can help reduce bleeding and limit swelling to
speed the recovery process. The bandage, or tubigrip applied must
be sufficient to accommodate swelling and should be removed when
the ankle is in elevation.
Elevation helps the body to drain the swelling away from the
injury site. In the first 72 hours after an injury it is advisable to
elevate it as much as possible. This would ideally mean resting the
ankle on a cushion, above the level of your heart.
Rehab Exercises
As soon as pain allows you should start mobilising the ankle. There are four basic
movements that occur at the ankle joint and these are the best exercises to start
with. You should find that the more you do, the easier they become. You may not
manage many in one to begin with. Do about 5 repetitions, 4 times throughout
the day.
Range exercises:
· Bend your foot up and down slowly
· Move your foot in and out slowly
Weight bearing:
Putting weight through the foot is also important for a fast recovery. When
walking you should avoid limping even if there is still some discomfort or it means
slowing down. Initially you may need to practise to make sure you are walking
with a normal gait pattern. The heel is the first part of your foot that should hit
the floor. As you step through, ensure you allow all your weight to move onto
your supporting foot. You should also check your strides are the same length. If
you need to shorten one stride, do the same with the other leg to make your
walking pattern symmetrical.
Progressive exercises restore balance, strength and flexibility:
· Practise standing on your affected foot without
holding on and count to 60.
· Stand with your affected foot behind you and keep your heel on the
floor as you lean forwards until you feel a stretch on your calf. Make
sure your feet are both pointing straight ahead. Hold this for 20
seconds and repeat the exercise 3 times.
· Stand and hold on to a support and raise up on to
your toes and slowly lower. Repeat 20 times. You
can progress by doing this exercise with just your
affected leg.
Seek Specialist help
When you sprain your ankle, it is important to regain full movement, strength and
balance. Seeing a specialist musculoskeletal physiotherapist will ensure your
ankle is given the best chance of a full recovery. The initial assessment will
identify any reduction in range, strength and importantly balance. Once you have
sustained an ankle injury, you are a lot more susceptible to further sprains if you
do not adequately rehabilitate the injured structures. Even if you feel that the
ankle is OK in daytoday
activities, it is worth making an appointment to check
that no underlying problems exist.
If you need further help, contact Pure Sports Medicine on 08447 700 800.
NOTE: The exercises and advice offered in this article should not worsen your symptoms.
If your symptoms worsen or stop improving then seek appropriate medical attention.