Managing ankle sprains
Ankle Sprains Part 1
A simple ankle sprain is often associated with acute pain and limited function but soon settles. However, about half of those patients go on to suffer chronic ankle instability (CAI) and pain where the ankle feels like it will give way under you. Fortunately many of the factors that impact negatively on a person’s ability to recover and stay injury free can be modified.
Patient-related factors such as loss of ankle mobility, reduced balance, lower body mass index (BMI), excessive flattening of the foot arch during running, weakness of ankle muscles, and slower muscle reaction time, are all factors that can be effectively managed with a tailored rehabilitation program designed in collaboration with your Mead Sports & Exercise Physio. Females have a greater risk profile for ankle sprains and therefore preventative strategies should be incorporated into any fitness regimen.
Environmental risk factors for ankle sprain/re-injury appear to be the sport played (highest in jumping and landing sports), the surface played on (grass having a higher risk compared to artificial turf), team position (defenders having a higher risk compared to midfield/attackers), and competition (in-competition activities have higher risk compared to training activities).
Ankle Sprains Part 2
Should I tape or brace my ankle after a sprain?
The best available evidence indicates that even a severe ankle sprain should not be immobilised for more than a few days before early controlled movement and weight bearing commence and muscle re-training implemented. Braces that have a lace-up bracing system combined with straps are a good choice for higher level sprains.
Taping an acute ankle in the early stages is not recommended as it acts like a rigid tourniquet restricting the flow of fluid/blood and rendering the athlete more prone to blood clots. Whether you choose a brace or tape will depend upon useability and cost. Ankle bracing should provide a better longer term option for both aspects.
Ankle Sprains Part 3
Should I get an Xray?
Only 15% of patients undergoing an Xray with ankle sprains have a fracture so it is important to choose who gets them to avoid radiation and unwanted costs. This is where the Ottawa ankle rules come in. If you are unable to walk on the injured ankle and have soreness at specific points around the ankle then an Xray may be warranted. In the case of ongoing ankle pain and disability, the scan of choice is the MRI because of its high degree of accuracy. Wording in the highlighted box “Mead Physios can organise any necessary scanning and commence proven early treatment strategies”.
Ankle Sprains Part 4
Physio or Doctor?
Sports & Exercise Physios are experts at diagnosis and injury management. For most ankle sprains they should be the preferred health practitioner of choice. Medical assessment should be reserved for more serious injuries involving the likelihood of bone injury involving higher levels of trauma.
How soon should I see my Mead Sports & Exercise Physio?
The best available research evidence suggests that delaying the assessment by 4-5 days allows the acute pain and swelling to subside and allow more accurate assessment in the rooms. An accurate clinical assessment by your physio at Mead will in most cases be as accurate as an ultrasound scan. Proven early treatment after the first 4-5 days will allow better chance of reducing re-injury and allow a quicker recovery.
What about RICE?
Rest Ice Compression Elevation (RICE) has no benefit when used in isolation but can dramatically improve pain levels and function if combined with early active movement and rehabilitation.
Anti-inflammatory (AI) medication?
AI’s do reduce pain and inflammation in the acutely sprained ankle. However, it does delay the natural healing instigated by the bodies defence systems. Consequently, it is recommended that simple analgesia, combined with RICE and early mobilisation should be implemented in the first 4-5 days and then NSAID’s either prescription or over-the-counter strength would be appropriate thereafter for short (less than 2 weeks) use.
Ankle Sprains Part 5
What exercises should I do?
A rehabilitation program that is supervised is superior to one that isn’t as it allows the development of correct strategies and proven exercise protocols. Importantly, exercise commenced early will significantly reduce recurrence rates (chances of an ankle sprain occurring again), improve recovery time allowing faster return to normal daily activities and sport, and minimise the probability of ongoing pain and instability in the ankle. Wording in highlighted box reads “The most proven exercise routines for ankles are ones that include functional strengthening and balance.
What about surgery?
These days surgery of the ankle for sprains is reserved for those that repeatedly twist their ankle. A general concept is if you sprain your ankle more than 3x in a year requiring considerable (more than 10 days) recovery time, and this process occurs for 3 years or more, then you would be a candidate for possible surgery. However, about 70% chronically unstable ankles also do very well without surgery and therefore surgery should be implemented only when an extensive rehabilitation program has failed.
Not sure what to do?
Jason Wells is a highly experienced and qualified Sports & Exercise Physio who can assist you over the phone via our tele-consult service. For a small fee Jason can advise and assist you through the recovery stages of any injury. Contact our office if you are interested in this service.