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EPISODE 38: How to Prevent and Manage Ankle Sprains

Ankle sprains are one of the most common injuries in the athlete. Athletes who play sports that involve running, jumping, and transitions may sprain their ankles a few times throughout their professional careers. The key to avoiding an ankle sprain is ankle health and hygiene. No- you don't have to brush your ankles, haha, but you do have to take care of them! That is really what hygiene is. Hygiene are behaviors that lead to good health. What is your ankle hygiene like? This blog is going to educate you on what an ankle sprain is, what you can do to manage them when they occur, and how you can develop good ankle hygiene!

So, let's dive right on in!

An ankle sprain is when you overstretch a ligament in your ankle. A ligament is a tough band of fibrous tissue that connects one bone to another. Ligaments play a huge role in providing stability to a joint, in this case, the ankle joint.

Medial and Lateral Ankle Anatomy

There are 4 main ligaments in the ankle that can be sprained:

(1) Anterior talofibular

(2) Calcanealfibular

(3) Posterior talofibular

(4) Deltoid

These 4 ligaments provide stability to the ankle. The first 3 ligaments are on the outside of the ankle. The Deltoid ligament is on the inside of the ankle. When a ligament gets overstretched, your body responds with protection to the ankle. Once an injury has occurred to the ligament, the body wants to limit further damage and prevent additional injury to the affected ankle. The body sends cells to the area to stabilize the injured area by restricting movement. These cells swell the ankle up. The cells are great to alert and protect us, but they can often linger around and irritate the ankle. We call this swelling or inflammation.

Ankle Sprains

The mechanism of injury of your ankle sprain will determine which ligament in your ankle you have sprained.

There are 2 main types of ankle sprains:

1. Inversion sprains: occur when your ankle goes "inward" and will result in a sprain to your lateral ankle ligaments. Inversion sprains are far more common and often result from activities that include sudden changes of direction, landing awkwardly from a jump, or stepping or moving on uneven surfaces.

2. Eversion sprains: occur when your ankle goes "outward" and will result in a sprain to your medial ankle ligaments. Eversion sprains are less common and happen when the foot is forcibly twisted outward. Eversion sprains are also associated with activities sudden twisting or impact, such as awkward landings or collisions during sports.

When a ligament is sprained, healthcare practitioners grade the sprain and the time it will take to heal based on the severity. Ankle sprains are often classified into three grades based on their severity. The grading system helps healthcare professionals determine the extent of ligament damage and appropriate treatment.

The three grades of ankle sprains are:

  1. Grade I (Mild): In a Grade I sprain, the ligaments are stretched but not torn. There may be mild swelling, tenderness, and some discomfort, but the joint remains relatively stable.

  2. Grade II (Moderate): A Grade II sprain involves partial tearing of the ligament. This can result in more significant pain, swelling, and bruising. The joint may be moderately unstable, and there might be difficulty bearing weight on the affected ankle.

  3. Grade III (Severe): In a Grade III sprain, the ligament is completely torn. This leads to significant pain, swelling, and bruising. The joint is often unstable, and weight-bearing can be very challenging. Severe cases may require medical attention, including possible surgical intervention.

Now that we have covered what an ankle sprain is and how it occurs let's talk about what you can do when it occurs. The treatment and management of an ankle sprain depends on the severity of the injury (which we explained above). Below, we cover the phases of treatment, goals, and strategies.

Acute Phase (1-2 weeks )

  • Goals: Reduce pain, swelling, and inflammation; protect the injured area from further damage.

  • Strategies:

    • Active Rest: Avoid activities that worsen the injury, but keep doing what feels good

    • Ice: Apply ice to reduce pain. 15-20 minutes every 2-3 hours as needed.

    • Compression: Use a compression bandage and/or taping techniques to control swelling, reduce pain, and provide stability

    • Elevation: Keep the injured area elevated to minimize swelling.

    • Pain Management: Over-the-counter pain relievers may be used under medical guidance.

    • Medical Evaluation: If the sprain is severe, involves a complete ligament tear, or if there is persistent pain and swelling, it's essential to seek medical attention. In some cases, surgical intervention may be necessary

    • Immobilization: In more severe cases, a brace, splint, or walking boot may be recommended to immobilize the ankle and provide support during the healing process.

    • Initiate Physical Therapy: physical therapy exercises can help manage pain and swelling and begin movement in the ankle.

Subacute Phase (2-6 weeks )

  • Goals: Gradually restore range of motion, begin gentle strengthening exercises, and improve joint function.

  • Strategies:

    • Therapeutic Exercises: Introduce controlled exercises to improve mobility, flexibility, strength, and proprioception.

    • Soft Tissue Mobilization: Use manual techniques to reduce swelling and improve tissue quality

    • Joint Mobilization: Use manual techniques to enhance joint mobility.

    • Gradual Return to Activity: Begin reintroducing functional activities under professional guidance

Rehabilitation Phase:(4-12weeks)

  • Goals: Build strength, flexibility, and endurance; improve functional capacity.

  • Strategies:

    • Progressive Exercise: Advance strengthening, build ankle resilience

    • Sport-Specific Training: Tailor rehabilitation to the specific demands of the activities or sport, including running, cutting, pivoting, jumps

    • Neuromuscular Training: Focus on balance, coordination, and proprioception.

Return to Play Phase: (8-12 weeks)

  • Goals: Ensure readiness to return to full activity or sports participation.

  • Strategies:

    • Functional Testing: Assess the ability to perform sport-specific movements without pain or limitations.

    • Gradual Return: Gradually reintroduce full activity or sports participation.

Maintenance/Prevention Phase: ongoing aka Ankle Hygiene

  • Goals: Maintain gains achieved during rehabilitation and prevent re-injury.

  • Strategies:

    • Continued Exercise: Engage in a maintenance program that includes regular exercise to sustain strength, mobility, flexibility, balance, and control in your ankle. Some of my favorites are SL heel raises, SL dynamic balance activities, lunges, step downs/ups, jumps, hops, and footwork on ladders.

    • Injury Prevention Strategies: Implement strategies to reduce the risk of future injuries, such as proper warm-ups, cool-downs, conditioning, movement mechanics, and recovery.

The sauce in rehabilitation is getting with an expert who knows how to rehabilitate ankle sprains and implement return to sport training. This is a graded process, and it takes time and commitment on behalf of the athlete. Injuries take time to heal, but if you do it right, you will be able to prevent future injuries and develop a resilient and strong ankle. You will also develop good ankle Hygiene.

If you are struggling with an ankle sprain, don't wait- get it checked out! Reach out because we would love to help you! We work with clients on-site and virtually through Telehealth. Click here if you are interested in booking a session or getting more information!

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Much Love <3 ,

The PTSP Docs

Dr. Brown, Dr. Bay, Dr. Daisuke & Dr. Sandoval

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