Ankle Sprains are also known as twisted ankle, sprained ankle, ankle injury, ankle strain.
Approximately 14% of all athletic injuries are ankle sprains and if not taken care of properly can lead to long term chronic ankle pain. The most common type is the inversion ankle sprain, in which the ankle rolls over on the outside. And you stretch and/or tear these ligaments. There is generally pain on the outside of the ankle. It can happen while hiking, playing sports walking on uneven surfaces, cross country skiing and dancing. All the usual things we do in the Truckee Tahoe area.
Sprained ankle causes:
A short or tight posterior calf muscles
Scar Tissue
Poor rehabilitation of a previous sprained ankle
Poor proprioception (proprioception is the ability to sense where a joint is .... if you don’t know where your ankle is, the muscles will not be able to prevent the ankle sprain)
Weak muscles (they are just not strong enough to prevent the sprain from occurring)
Poor control of the muscles and joints
First degree ankle sprain:
Some stretching or mild tearing of the ligament.This pain would be on the outside of the ankle just below, in front of and in back of the lateral malleous (commonly kmown as the ankle bone)
Little or no functional loss - the joint can still function and you can walk but with pain without limp
Mild pain
Some swelling
Some joint stiffness.
Takes 2-4 weeks to properly heal
Second degree ankle sprain:
Significant tearing of the ligament up to 75%
Moderate instability of the joint i.e. the joint feels loose
Moderate to severe pain - weight bearing is very painful in the above areas and onto the top of the foot and up the outside of the lower leg
Can not walk without severe pain
Swelling and stiffness
Muscle involvement indicated by the pain goes up the side of the leg
Takes 6-10 weeks to heal
Third degree ankle sprain:
Total rupture of a ligament - there is a loss of motion
Gross instability of the joint - joint function is lost
Severe pain initially followed by no pain
Severe swelling
Takes 16 to 20 weeks to heal
Chronic ankle sprain:
After 9 months you still have pain
30% of ankle sprains fall into this category. Do not let yourself fall into this category, if you do give the rehab 110% you likely will.
Causes of chronic ankle sprains
We find that the primary reasons are adhesions in the surrounding ligaments, tendons and muscles
Poor rehabilitation
Poor exercise compliance
Poor rehabilitation
A fracture that was not initially diagnosed
Congenital abnormality i.e. you were born with abnormal structure and/or posture of the foot, knee, hip, spine
Post traumatic arthritis
Osteochondritis dissecans (loose bit of bone in the joint)
Syndesmotic ligament injury sometimes called a high ankle sprain
Functional instability (a feeling of ‘giving way’)
Ankle impingement this is when the bone has grown an extra process (extension) and it stops movement
Tight calf muscles
Treatment
When you do sprain your ankle you should start treatment as soon as possible this well help prevent chronic pain and long term instability
For all grades of ankle sprain follow the R.I.C.E. principles as soon as possible:
Rest your ankle - do not walk on it.
Ice - this helps to keep the swelling down. Use ice on the injury several times a day for 15-20 minutes (more than 20 minutes is not advised). This can be done once per hour
Compressive bandages are needed to immobilize the ankle sprain and to support the injury.
Elevate the ankle above your heart level for as much as you can for 48 hours.
Seek professional advice from your chiropractor, sports medicine specialist, physical therapist or physician.
As soon as treatment is started, consideration must be given to:
Active Release Techniques®
Adequate rehabilitation
Exercises to increase proprioception and balance
Ankle braces and strapping to facilitate activity an aircast® is a great choice
Muscle strengthening and flexibility exercises
Gradual return to any sporting activities in Tahoe and Truckee
Maintain fitness by doing alternative activities
Range of motion exercises
Balance
Chiropractic
Prevention of the sprained ankle
A number of things can be done to prevent an ankle sprain, especially if there is a history of recurrent sprained ankles:
More Rehabilitation
Orthotics/arch supports
Continue to stretch the calf muscles, strengthen the muscles
Balance exercises
Use strapping, taping or an ankle brace an aircast® is a good choice
Sometimes a wedge in the shoe will help prevent the ankle from ‘tipping over’ - this is particular helpful in those who ‘roll’ their ankle a lot
Better quality shoes
High top shoes
No high heels
A shoe in good shape i.e. the part that hold the heel is sturdy and the sole is not worn, no sandals
