How to manage an ankle sprain.

July 13, 2010
by Justin

Have you ever sprained your ankle? Ever feel like it won’t heal? Well here at Scoutme.com we wanted to take a deeper look into what an ankle sprain really is and how to properly treat it. So we turned to WebMD and American Academy of Orthopedic Surgeons to give us some advice and direction on how to manage an ankle sprain. An ankle sprain occurs when ligaments that connect the bones in the foot, ankle, and lower leg are stretched or torn. There are variations of sprains and varying degrees as well. The three types are:

  1. An inversion injury is the most common cause of an ankle sprain and occurs when the ankle rolls outward and the foot turns inward. It results in stretching and tearing of the ligaments on the outside of the ankle.
  2. Less commonly, the ankle rolls inward and the foot outward in an eversion injury, damaging the ligaments at the inside of the ankle.
  3. The high ankle sprain is the least common. It can happen when the foot is forced to rotate toward the outside (away from the other foot), or when the foot is planted so it can’t move and the leg is rotated toward the inside.

Additionally, there are varying degrees or severity of sprains. This is determined by the amount of force applied to the occurrence. A mild sprain is a Grade 1. A moderate sprain is a Grade 2. A severe strain is a Grade 3 (see Table below).

  • Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament.
  • Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (laxity) of the ankle joint occurs.
  • Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, gross instability occurs.

Most people know when they have a sprain, but what most people don’t know is how to handle a sprain. Often they are neglected or handled improperly by the student athlete. If a sprain is not treated properly with the necessary attention, chronic problems of pain and instability may result. This will most certainly prevent any student athlete from performing at their peak ability. So we did a little research in order to educate student athletes on how to treat them properly. Note before we continue, it is always recommended to seek medical attention when dealing with any injury in order to handle injuries properly.

Initially with sprained ankles walking may be difficult because of the swelling and pain. You may need to use crutches if walking causes pain. Usually swelling and pain will last two days to three days. Depending upon the grade of injury, the doctor may tell you to use removable plastic devices such as cast boots or air splints.

Most ankle sprains need only a period of protection to heal. The healing process takes about four weeks to six weeks. The doctor may tell you to incorporate motion early in the healing process to prevent stiffness. Motion may also aid in being able to sense position, location, orientation and movement of the ankle (proprioception). Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. And even if an ankle has a chronic tear, it can still be highly functional because overlying tendons help with stability and motion. So motion is extremely important.

For a Grade 1 sprain, use R.I.C.E (rest, ice, compression and elevation):

  • Rest your ankle by not walking on it.
  • Ice should be immediately applied. It keeps the swelling down. It can be used for 20  minutes to 30 minutes, three or four times daily. Combine ice with wrapping to decrease  swelling, pain and dysfunction.
  • Compression dressings, bandages or ace-wraps immobilize and support the injured ankle.
  • Elevate your ankle above your heart level for 48 hours.

For a Grade 2 sprain, the RICE guidelines can also be used. Allow more time for healing to occur. The doctor may also use a device to immobilize or splint the ankle.

A Grade 3 sprain can be associated with permanent instability. Surgery is rarely needed. A short leg cast or a cast-brace may be used for two weeks to three weeks.

Rehabilitation is used to help to decrease pain and swelling and to prevent chronic ankle problems. Ultrasound and electrical stimulation may also be used as needed to help with pain and swelling. At first, rehabilitation exercises may involve active range of motion or controlled movements of the ankle joint without resistance. Water exercises may be used if land-based strengthening exercises, such as toe-raising, are too painful. Lower extremity exercises and endurance activities are added as tolerated. Proprioception training is very important, as poor propriception is a major cause of repeat sprain and an unstable ankle joint. Once you are pain-free, other exercises may be added, such as agility drills. The goal is to increase strength and range of motion as balance improves over time.

All ankle sprains recover through three phases:

  • Phase 1 includes resting, protecting the ankle and reducing the swelling (one week).
  • Phase 2 includes restoring range of motion, strength and flexibility (one week to two weeks).
  • Phase 3 includes gradually returning to activities that do not require turning or twisting the ankle and doing maintenance exercises. This will be followed later by being able to do activities that require sharp, sudden turns (cutting activities) such as tennis, basketball or football (weeks to months).

You will want to begin building strength and restoring range of motion back to the ankle. Rehabilitation exercises are critical to ensure that the ankle heals completely and reinjury does not occur. During phases 1 & 2 of the recovery process you can do the following exercises. Keep in mind it is imperative that you consult a doctor immediately upon injury and before you participate in any rehab or treatments. The healing process begins immediately; with even the most simple of activities like walking or even just bearing some weight on the foot. But only do so if you feel minimal pain.

Next you can start rehabilitation with range-of-motion exercises in the first 72 hours after your injury. Continue with further rehabilitation, including stretching, strength training, and balance exercises, over the next several weeks to months. Be sure to start each exercise slowly and use your pain level to guide you in performing these exercises. Ease off the exercise if you have more than mild pain. Keep in mind that the timing and type of rehabilitation exercises recommended for you may vary according to your doctor’s or physical therapist’s preferences.

Range-of-motion exercises
Range-of-motion exercises begin right after your injury while you have ice on your ankle. Perform a set of exercises by repeating them 10 to 30 times. Do each set 3 to 5 times a day.

  1. Trace the alphabet with your toe, which encourages ankle movement in all directions.
  2. Sit in a chair with your foot flat on the floor. Slowly move your knee side to side while keeping your foot pressed flat.

While sitting, place a hand towel on a smooth floor, such as wood or tile. While keeping your heel on the ground, curl your toes and grab the towel with your toes to scrunch the towel. Let go, and continue scrunching up the entire length of the towel. When you reach the end of the towel, reverse the action by grabbing the towel with your toes, scrunching it, and pushing it away from you. Repeat, until you have pushed the entire length of the towel away from you.

Stretching exercises
Start exercises to stretch your Achilles tendon as soon as you can do so without pain. The Achilles tendon connects the calf muscles on the back of the lower leg to the bone at the base of the heel.

  1. Towel Stretch: If you cannot stand, sit with your knee straight and a towel looped around the ball of your foot. Gently slowly pull back on the towel for about 15 seconds until you feel your calf stretch. In moderate to severe ankle sprains, it may be too painful at first to pull your toes far enough to feel a stretch in your calf. Use caution and let pain be your guide. A little pain is normal, but you should not feel moderate to severe pain. Do 15 to 20 repetitions of this exercise, 3 to 6 times a day.
  2. Calf Stretch: If you are able to stand, you can do this exercise by facing a wall with hands at shoulder level on the wall. Place your injured foot behind the other foot with the toes pointing forward. Keep your heels down and your back leg straight. Slowly bend your front knee until you feel the calf stretch in the back leg. Hold this position for at least 20 seconds and repeat. Try to do this stretch 3 to 6 times a day.

Muscle-strengthening exercises
Talk to your doctor or physical therapist about the timing of strengthening exercises for the ankle. Generally, you can start them once you are able to stand without increased pain or swelling.
These exercises should be held for 3 to 5 seconds. Do 15 to 20 repetitions once or twice daily for 2 to 4 weeks, depending on the severity of your injury.

  1. Start by sitting with your foot flat on the floor and pushing it outward against an immovable object such as the wall or heavy furniture. After you feel comfortable with this, try using rubber tubing looped around the outside of your feet for resistance.
  2. While still sitting, put your feet together flat on the floor. Press your injured foot inward against your other foot.
  3. Next, place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with your injured foot.
Balance and control exercises
You can usually start balance and control exercises once you are able to stand without pain. But talk to your doctor or physical therapist about the exact timing. Also, don’t try these exercises if you could not have done them easily before your injury. If you think you would have felt unsteady doing these exercises when your ankle was healthy, you are at risk of falling when you try them with an injured ankle.

Do these exercises 6 times for 60 seconds at least once a day.

  1. Stand on just your injured foot while holding your arms out to your sides with your eyes open. When you can do this for 60 seconds, try adding the advanced moves in the next level.
  2. Stand on your injured foot only and:
    Hold your arms across your chest with your eyes open.
    Hold your arms out to the sides and close your eyes.
    Hold your arms across your chest and close your eyes.

Stretching exercises should be continued on a daily basis and especially before and after physical activities to prevent reinjury. Even after your ankle feels better, continue with muscle-strengthening exercises and balance and control exercises several times a week to keep your ankles strong.
If you have sprained your ankle in the past, you may continue to sprain it if the ligaments did not have time to completely heal. If the sprain happens frequently and pain continues for more than four weeks to six weeks, you may have a chronic ankle sprain. Activities that tend to make an already sprained ankle worse include stepping on uneven surfaces, cutting actions and sports that require rolling or twisting of the foot, such as trail running, basketball, tennis, football and soccer.

Possible complications of ankle sprains and treatment include abnormal proprioception. There may be imbalance and muscle weakness that causes a re-injury. If this happens over and over again, a chronic situation may persist with instability, a sense of the ankle giving way (gross laxity) and chronic pain. This can also happen if you return to sports or other activities without letting the ankle heal and become rehabilitated.

Even though ankle sprains are one of the most common injuries they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems down the road. Please remember to always consult a doctor when injury occurs and never let an injury go untreated, it will prevent you from performing to the best of your ability.

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