A sprain is a part or complete rupture of a ligament. Ligaments hold bones together, so they need to be strong and stable. They can be tricky to rehabilitate fully after injury as they have a poor blood supply which slows down the healing process. If a rehabilitation programme is followed correctly they can heal well - but not looking after sprains properly can lead to further injury.
Ankle sprains are a common injury in sport but can also happen regularly in daily life. Uneven pavements, wearing high heels, or slipping off a curb are all ways we can ‘go over’ on our ankle. The most common type of ankle sprain is the inversion-type or lateral (outside) ligament sprain which accounts for 85% of all ankle sprains.
The ankle joint is the body part that is second-most likely to be injured in sport, with indoor sports such as basketball being the main cause. The joint most likely to be injured is the elbow if you take part in racket sports like tennis, badminton, or squash.
There are numerous risk factors that determine whether someone is likely to have ankle instability. The most common factor is previous injury, which comes back to that issue of poor rehab. A history of spraining your ankle can compromise the ligaments that support the ankle and provide integrity to the joint. Intrinsic factors such as height, weight, body sway, and the structure of your foot can mean you are more predisposed to getting sprains. Extrinsic factors would also include the type of shoes you wear, how much activity you do and the intensity of that activity.
How do you know it is a sprain?
The severity of your ankle sprain is graded 1 to 3. Each grade has different symptoms and will determine what treatment plan is put in place.
Grade I: Mild - Little swelling and tenderness with little impact on function
Grade II: Moderate - Moderate swelling, pain and impact on function. Reduced proprioception, Range Of Movement, and instability
Grade III: Severe - Complete rupture, large swelling, high tenderness, loss of function and marked instability.
So it's likely to be a sprain or strain if:
· you have pain, tenderness, or weakness in the area
· the injured area is swollen or bruised
· you can’t put weight on it or use it normally
· you have muscle spasms or cramping – where your muscles painfully tighten on their own.
There are a few ligaments in the ankle that could be affected following an injury. On the lateral side of the ankle, which is where people normally hurt themselves, you have the anterior talofibular ligament, calcaneo-fibular ligament and the posterior talofibular ligament. The anterior talofibular ligament is the one most people sprain.
How does the common lateral sprain happen?
Lateral sprains normally occur when our body weight quickly shifts over our landing or weight-bearing foot. We roll our ankle which stretches the lateral ligament and tears it.
Strangely in a 1994 study, Yeung et al, found that a person’s dominant leg is 2.4 times more vulnerable to sprains than the non-dominant leg. You’d think it would be the other way around, but it’s not.
How to treat an ankle sprain
When you first go over on your ankle it is going to be sore and potentially even swollen for a few days. At this point it is classed as an acute injury, so manual therapists shouldn’t touch it for 48-72 hours. During this time, you should follow the P.R.I.C.E principles.
· P – Protect the injured area. If it’s an ankle use crutches to stay off load-bearing
· R – Rest
· I – Ice
· C – Compression
· E – Elevation
What will a therapist do?
In order to establish which ligaments are causing the pain your therapist will perform a number of tests as well as watch you walk and look for swelling and bruising around the area.
Once they have a good idea of which areas need working on, they can then start to treat the injury.
A combination of massage techniques such as cross fibre frictions to the damaged ligament breaks down any scar tissue and encourages more blood flow to the area. Effleurage flushes out all the debris and stimulates healing and k-tape (therapeutic kinesiology tape) can often help support the joint in between sessions. helps reduce pressure to the tissue and may reduce discomfort or pain. Correct taping also gives support to muscles by improving the muscle's ability to contract, even when it’s weak, and helps the muscle to not over-extend or over-contract.
You may also be given exercises to build the ligaments back to their pre-injury condition.
To help prevent these sprains from re-occurring as they so often do, the best thing to do is make sure you stick to your rehab programme properly and don’t go back to your activity too soon.
Have you ever sprained your ankle? Do you still get a niggle or a feeling it just isn’t quite right?
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