Best Practices for Managing Acute Ankle Sprains

What is a Sprain?

A sprain is a type of soft tissue injury that primarily affects the ligaments, which are the tough, fibrous tissues connecting bones at a joint. Ligaments provide stability and support to the joints, and they are not designed to stretch. However, when subjected to an excessive force, such as during a sudden twist or impact, they can become overstretched or even rupture. This type of injury is referred to as a sprain.

What are the Symptoms?

The symptoms of an ankle sprain can vary in severity, but they commonly include:

• Pain: This can range from mild discomfort to severe pain, depending on the extent of the injury.
• Swelling: The affected area often becomes swollen due to inflammation.
• Bruising: Discoloration can occur as a result of bleeding under the skin.
• Difficulty Weight Bearing: Walking or putting weight on the injured ankle can be painful or impossible.
• Decreased Muscle Power: The muscles around the injured area may feel weak or give out.

What Structures are Involved?

Ankle sprains most frequently involve the lateral side of the ankle, accounting for approximately 85% of all ankle sprains. This typically involves the anterior talofibular ligament (ATFL), which is the most commonly injured ligament when the foot rolls inward.

Less common are medial (inside of the ankle) and syndesmotic (high ankle) sprains, which often require more extensive rehabilitation due to the complexity and severity of the injuries.

When Should I Get Scans?

To determine the necessity of an X-ray, follow the Ottawa Ankle Rules. These guidelines help identify when a fracture might be present and include:

1. Bony Tenderness Along the Distal 6 cm of the Posterior Edge of the Fibula or Tip of the Lateral Malleolus: Tenderness in this area could indicate a fracture.
2. Bony Tenderness Along the Distal 6 cm of the Posterior Edge of the Tibia or Tip of the Medial Malleolus: Similar to the above, but on the inner side of the ankle.
3. Bony Tenderness at the Base of the 5th Metatarsal: Tenderness here can suggest a break in this bone.
4. Bony Tenderness at the Navicular: This is a small bone on the inside of the midfoot.
5. Inability to Bear Weight Both Immediately After Injury and for Four Steps During Initial Evaluation: If the person cannot walk four steps immediately after the injury and during the initial evaluation, an X-ray is warranted.

Your physiotherapist can assist you in determining the need for an X-ray based on these criteria.

Acute Management

During the acute phase of an ankle sprain, the goal is to alleviate pain and swelling and regain basic function. Adhering to the POLICE principle is recommended:

• Protection: Use supportive footwear, taping, bracing, or CAM boots to protect the injured ankle.
• Optimal Loading: Begin gentle range of motion exercises as soon as possible to maintain mobility without causing further damage.
• Ice: Apply ice to the injured area to reduce swelling and numb the pain.
• Compression: Use compression garments, such as tubigrip or compression socks, to help control swelling.
• Elevation: Elevate the injured ankle above heart level to reduce swelling.

Typically, pain and swelling are most pronounced during the first 3-5 days following the injury.

What Does Rehabilitation Look Like?

Rehabilitation for an ankle sprain progresses through several stages:

1. Early Stage: Focuses on improving the range of motion and reducing swelling. Gentle exercises to maintain mobility and circulation are initiated.
2. Mid Stage: As pain decreases, the emphasis shifts to regaining strength and improving impact tolerance. This might include weight-bearing exercises, resistance training, and balance exercises.
3. Late Stage: Concentrates on enhancing agility, coordination, and sport-specific activities. The goal is to return to pre-injury levels of performance safely and effectively.

When Should You Contact Your Physiotherapist?

It is advisable to contact your physiotherapist if:

• The injury impedes your ability to participate in sport or daily activities for more than 1-2 days.
• You are unsure about the severity of the injury or the appropriate management steps.
• You experience severe pain, significant swelling, or difficulty bearing weight.

Early intervention by a physiotherapist can significantly enhance recovery outcomes and prevent future complications.

Conclusion

Ankle sprains, while common, can be effectively managed with the right approach. Understanding the nature of the injury, recognising the symptoms, and following best practices for acute management and rehabilitation are crucial steps toward a full recovery. Always consult a healthcare professional to tailor the management plan to your specific needs and ensure a safe return to your activities.

Written by Ashley McGuiggan – Physiotherapist