This injury is probably the most common in the realm of musculoskeletal disorders. The majority of ankle sprains (approximately 85%) occur when the foot makes an excessive inversion movement, meaning it rolls inward beyond its capacity. The same mechanism of injury occurs less frequently in the opposite movement.
This mechanism causes the ankle ligaments, which are responsible for maintaining the bones and joint in their position, to undergo abnormal movements such as twists and rotations of the foot. When a ligament is forced beyond its normal capacity, a sprain occurs.
Sprains are classified into three grades:
Grade I – there is a mild stretching of the ligament fibers.
Grade II – where a partial tear occurs.
Grade III – complete ligament rupture: the most severe case.
The symptoms of a sprain are immediate or occur in the following hours, and the most common ones are:
Tenderness to the touch;
Pain;
Local swelling, in the form of edema (accumulation of fluids) and/or hematoma (accumulation of blood);
Redness and increased temperature of the area;
Difficulty walking.
The risk factors for this injury are: sports that involve jumping/leaping movements and running. Good examples are basketball, volleyball, skateboarding, trail running, and soccer. Other risk factors include predisposing anatomical changes (such as differences in leg length or ligament laxity).
But what should be done when the injury occurs?
In my experience, one of the biggest mistakes people make is underestimating a sprain. The first action to be taken is to see a doctor (physiatrist, orthopedist, emergency room in a hospital near you) to determine if there was a bone fracture through an X-ray and the state of the ligaments with a magnetic resonance imaging.
After these two complementary exams have been performed, the degree of the injury, as previously mentioned, is diagnosed. Depending on the degree of the injury, there are medical and physiotherapy treatment protocols to follow.
During the acute phase, the doctor may prescribe:
Anti-inflammatory drugs;
Rest;
Application of ice;
Elevation of the foot above heart level;
Use of a bandage or boot to compress the injured area;
Crutches for walking assistance.
These measures aim to reduce inflammation, edema, pain, and weight on the affected limb.
All ankle sprains should be rehabilitated, from the less severe ones (which are often not treated due to a lack of awareness and understanding of the benefits of physiotherapy in this and other musculoskeletal injuries) to the more severe ones. Poorly healed injuries can lead to recurrences, meaning people with multiple repeated ankle sprains on the same foot. It should be noted that those who experience recurrences may become candidates for ankle surgery.
How can physiotherapy help?
Seek a physiotherapist for an evaluation and to establish the appropriate rehabilitation treatment for your case. Physiotherapy helps control pain and swelling, prevents chronicity of the problem, and, with an adequate exercise program, enables recovery of strength, flexibility, and stability in this joint.
Finally, let's talk about prevention. For this injury, the best prevention is rehabilitation. If you are an athlete, it is essential to have a proper warm-up; you should perform specific training programs for your sport and, not least, wear suitable footwear. This footwear should be replaced when wear on the sole is visible.
Ricardo Vargues | Physical therapist
Watch the video about ankle sprain:
References:
Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wickstrom EA. The epidemiology of lateral ligament complex ankle sprains in National Collegiate Athletic Association sports. American journal of sports medicine. 2016.The American Journal of Sports Medicine Vol 45.
American Orthopaedic Foot & Ankle Society.
Marc Reis e col., A Instabilidade Crónica da Articulação Tibio-Társica: Etiologia, Fisiopatologia e Métodos de Medição e Avaliação, Revista Portuguesa de Fisioterapia no Desporto.