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Sprained Ankle

What is an ankle sprain?

A sprain is commonly caused when a joint has gone beyond its usual comfortable range of motion. This results to a complete or partial tear of the supporting ligaments of the joint. The ligaments help to prevent excessive movement. Which is why a sprained ankle is a very common sports injury due to its highly mobile characteristics.  However, regardless of ligament’s tough fibrous tissue, predominantly composed of collagen fibres, which provide great tensile strength, an injury, such as this can still take place. This can result to these partial or complete tears of the fibres.

If you are suffering with a sprained ankle and want to talk to someone immediately, contact Molly Haskins – fully qualified Soft Tissue Therapist. However, if you want to know more about this injury & the prescribed treatments please read on.

Often the result of a twist on uneven ground, this runner has sprained her ankle

Categorisation of Ankle Sprain Injury

Sprains can be categorised as a first-, second- or third-degree sprain, depending on their severity. A first-degree ankle sprain is where the ligament’s fibres have experienced a minor partial tear or have just been overstretched. The joint should also retain most of its stability with little swelling around the injured joint.

A second-degree ankle sprain would mean that the ligament has more severely partially teared, swelling bruising and moderate pain would also be present. In addition, heat and redness would be present, due to excessive blood in the injured area.

Third-degree sprains are the most severe as the ligament (s) would be completely torn or ruptured and would most likely require surgical repair. The swelling of a third-degree sprain would be severe and if it were to occur at the ankle joint (talocrural joint) it would not be able to bear any weight and would be incredibly painful. If the ligament has torn completely or ruptured, making it a third-degree sprain, then the person may also hear and feel a pop at the ankle for example.  

There would also be severe swelling, loss of motion, instability of the joint and discolouration of the skin such as bruising (hematoma). It is advised that the individual should see a GP or go to A&E if a more serious ankle sprain has occurred (grade 2 or 3), as there is a possibility that a bone could be broken.

Most common Causes of a Sprained Ankle

Common causes of a sprained ankle may be walking, running or exercising on uneven ground may increase the risk of a sprain especially if stability, strength and balance are lacking. This is because the uneven surface can force the ankle out of its comfortable range of motion more easily. The knee could be easily sprained when pivoting for example in an athletic activity such as in a game of netball. The wrist may be sprained when falling and subsequently landing on the outstretched hand. A sprained thumb may take place during sports such as tennis or other racquet sports, when using back hand or through overextension. Lastly, contact sports are common causes also for sprains to occur due to the force of impact for example within a rugby tackle.

How can a therapist help

During the acute soft tissue inflammatory response stage of an injury, the injury will be in exceedingly early stages of recovery and the injured site is bound to be uncomfortable during this time. So, rehabilitation such as strengthening, stretching, aiding with the break down scar tissue through direct remedial massage etc may not be the best option during this first stage.

Image showing a therapist manipulating a sprained ankle

What to do in the acute phase? RICE

1) REST

During the first few days of acute soft tissue inflammation a protocol called RICE would be recommended to reduce the symptoms of the inflammation. This consist of the following steps to recovery: Rest, Ice, Compression and Elevation. Rest is an essential part of the procedure; this ensures that the injury is not aggravated. If the injury is not rested then the recovery process may struggle to take place as the inflamed soft tissues would still be working hard, which would put them under a great deal of stress. In addition, the inflammation could worsen as the injured site would be aggravated, preventing the healing process from taking place.

1b) Movement

However, after the first three days of adhering to the RICE procedure, MICE is recommended which replaces the idea of resting the injury to undertaking light Movement. Gentle exercises and stretches would ensure that whilst healing the injury does not become stiff. The pain threshold during the movement/mobilisation process should be mild, if it is unbearable then the client should not proceed in moving the injury. Further advice from a medical professional may be necessary. Movement that focuses on balance, joint flexibility and strength exercises after day 3 of recovery will aid with the rehabilitation period and decrease the risk of a re-occurring injury from taking place.

2) ICE

In regard to RICE, the next step is the appliance of Ice. This is recommended instead of heat as heat will encourage further fluids to the injured site which may adversely increase swelling further. Whereas ice reduces the pain and micro circulation to the injury which will ease symptoms. This should be done for no longer than 20 minutes and the ice should not be directly applied to the skin and can be applied every 1 to two hours in necessary.

3) COMPRESSION

Compression aids with the reduction in swelling and bleeding between the soft tissues. If the soft tissue inflammation were for example an ankle sprain compression would provide it with further support if the client needed to walk on it. This could be compressed using an elastic bandage, ensuring it is not too tight so that the blood circulation is not restricted. This can be compressed for 48 to 72 hours.

4) ELEVATION

The last stage is Elevation, if possible, the injured limb should be elevated above the heart to promote elimination of excess fluids, which will reduce the swilling too. If this protocol is followed correctly then the acute soft tissue inflammation should be reduced, and recovery will happen successfully.

Soft tissue therapy can then be useful after the first five days which will help with breakdown of scar tissue, which can affect the function of the muscle, increased microcirculation and aid with lymphatic drainage. Depending on how well the client has recovered, working around the injured site might be more beneficial until pain has subsided. It may take up to 6 weeks to fully heal, depending on the severity, which is why it is important to get help from a soft tissue therapist. The injury would be assessed, functional movement, proprioception exercises, active and recitative movements would be used during rehabilitation.

Disclaimer information

*This should not be taken as medical advice and you should still contact your GP/hospital if you suspect a serious injury. *