Ankle sprains are the most common sports injury seen at the emergency department or doctor’s clinic. They account for 25% of all sports injuries and are particularly common in indoor or court sports such as basketball, volleyball or squash. In a mild ankle sprain the initial injury may seem to resolve quite quickly, however, it is shown that you are twice as likely to sprain your ankle again within one year of the initial injury. Clearly there are some long-term consequences that need to be addressed.
There are three stages to the healing of a sprained ankle. The acute stage is when the ankle is swollen, perhaps bruised and very painful. You may not be able to bear any weight on the leg and the ankle feels hot. This usually lasts between 3 to 5 days. RICE (Rest, Ice, Compression, Elevation) is well known for the management in the acute phase. This helps reduce the inflammation and pain.
In the next stage the tissues start to repair, the inflammation reduces and the pain settles. Physiotherapy can help to speed up this stage using ultrasound and laser to promote tissue healing, soft tissue massage to reduce swelling and joint mobilisations and specific exercises to restore range of motion. This is a really critical phase and return to sport at this point is particularly dangerous. Depending on the extent of the injury it can take from 3 days to 6 weeks. In mild or moderate sprains this is when a lot of re-injuries happen: there is hardly any pain and we are tempted to go out and play sports again, but the ankle still needs protection and movements should be controlled, as strength and balance have not yet returned to pre-injury levels. And this is where most people stop. “I guess I just have weak ankles…”, they say.
However, there is more. The final stage is maturation when the area of healing becomes stronger and the body is ready to slowly be conditioned back to playing sport. This can take from 3 weeks to over 1 year. To avoid those long-term consequences and increased risk of recurrent ankle sprains your rehabilitation must go on.
Physiotherapy can guide you through this very important process. Prevention of re-injury is essential. An ankle brace or taping can be used to stabilise the joint and encourage the muscles to work correctly. Careful reconditioning will enable a faster and safer return to sport. The range of movement in the ankle needs to be restored with full muscle strength, coordination, balance and control. Special exercises called plyometrics are important to provide the speed of recovery and control that is required. These include burpees, box jumps and squat jumps. Balance can be improved using wobble boards, trampolines and exercises standing on one leg. Functional exercises, such as jumping, running and changing directions need to be perfected prior to returning to sport.
Going through the full rehabilitation required after an ankle sprain takes patience and dedication. However, it will also mean you never have to mention your ‘weak ankles’ again.
With thanks to Paula Robinson, BSc Physiotherapy.