The ankle joint is formed by four bones (tibia, fibula, talus and calcaneus). The stability of the joint is maintained by ligaments. Ligaments assist in guiding the normal movements of the joint and avoiding excessive movements. When an ankle is sprained, (usually caused by excessive side way bending of the ankle, for example walking on uneven surface or standing on someone’s foot) a ligament can be over stretched. This can lead to fibers of ligament and small blood vessels been torn. Then there will be symptoms like internal bleeding within the tissue, swelling and pain.
When an ankle sprain takes place, you need to immediately and within 72 hours of injury, apply RICE for management.
· Rest – Avoiding any painful movements
· Ice – Wrapping a wet towel around ice, then applying it on injured area for 20 minutes and repeating this process every two hours. This will help to control the amount of internal bleeding and pain.
· Compression – Using bandage to wrap around ankle and bottom half of the leg to minimize swelling
· Elevation – Positioning the ankle up high, above the heart level to decrease swelling
Within 48 hours post sprained ankle, it is important to avoid heat, alcohol, running and massage. This will prevent increases of swelling and will improve the healing process.
The rehabilitation process for ankle sprain can be started early on. Your physiotherapist can assist in minimizing ankle pain and movement restriction. Therefore, you can return to work and sport quickly. This process will also promote the healing of the ligament and the normal function of muscle and nerve.
Your physiotherapist will assess your sprained ankle to see which ligament is affected, how severe is the sprain and whether there is the need for x-ray. In the early stage of rehabilitation, it is mainly focusing on decreasing swelling and pain to allow ease in walking. Physiotherapist will mobilize your ankle joint to improve the mobility and to minimize joint stiffness. This will help to make walking easier and to form healthy scar tissue on the ligament. The ligament then will recover quicker and stronger.
Your physiotherapist will teach you some simple exercises to promote the strengthening of calf and ankle muscles. This will supplement the injured ligament. Muscle reaction will need to be trained as well. When the ankle position changes, muscles needs to react quickly in order to prevent re-injury of the ligament. Complete recovery of the ligament depends on the severity of the sprain. It can be few weeks up to few months. It is important to remember that pain and swelling will settle much quicker than the recovery of the muscle and ligament strength. Therefore, returning to work or sport too early can slow down the overall healing process. Your physiotherapist can teach you the use of ankle taping or brace to support your ankle to avoid further irritation while allowing you to return to normal daily routines.
The following methods can help you to minimize the chance of spraining your ankle and to minimize the severity of injury:
· Wearing suitable shoes or applying sports tapes to provide good support at the ankle joint
· Avoiding activities on slippery or uneven surfaces, including low light/dark locations
· Strengthening the calf muscle to protect your ligaments
· Practice standing on one leg to improve your balance reaction
· Always do warm up before activities
If you have any questions, please contact your physiotherapist.
By Terry Kung