Most athletes are no stranger to a sprained ankle. Though they can be possibly traumatic, often times they seem more like a painful annoyance keeping us from our game. Ankle sprains are more common in sports with increased lateral movement, as in tennis or basketball, but can affect anyone. In this article I will describe the anatomy involved, recovery and rehabilitation, and discuss bracing and prevention.
Ankle sprains can be generally grouped in three categories based on location; medial, lateral, or syndesmotic. In medial sprains the ligaments on the inside of the ankle are compromised by the ankle being forcibly everted (rolled out). Lateral sprains are just the opposite; forceful inversion (rolling in) injures the ligaments on the outside of the ankle. Inversion/ lateral ankle sprains are more common because of people’s natural range of motion. Syndesmotic sprains are caused by stretching of the fibrous membrane and the tibiofibular ligaments connecting the two bones of the lower leg. Because of the area injured they are also called “high ankle sprains.” High ankle sprains are less common, but can be very seriously and present along with a fracture. Ankle sprains are graded 1, 2, or 3. Generally, 1 is categorized as stretching of the ligaments, 2 is a partial tear, and 3 is a full tear and would require surgery.
Should you unfortunately sprain your ankle and cannot return to play your first step is R.I.C.E. Rest.Ice.Compression.Elevation. Heat should not be applied to an acute injury, and the combination of ice, compression and elevating the injured ankle while lying down will help decrease the amount of swelling in the area. Rehabilitation can start almost immediately, using pain and instability as a guide for progression. Initial exercises will be done while not bearing weight and are designed to help decrease swelling. Examples include; ankle pumps with the leg elevated (as if you are pressing down on the gas pedal) and tracing the alphabet with your foot to help maintain or increase range of motion. Once range of motion is restored, resistance is added to the same motions, either by a band or manually. Eventually the injured ankle will return to its previous level of strength and exercises become more about balance, coordination and agility. Standing on the injured foot or single leg calf raises are two examples of these initial balance exercises. Standing on the injured foot can be progressed a multitude of ways; increasing the time, closing your eyes, standing on a soft surface (such as an Airex pad), or balancing and performing a movement (i.e. squat or ball toss). Coordination and agility could be considered the final steps in the rehabilitation process and depending on pain level may take place simultaneously with returning to play. Exercises are designed to be specific to the sport such as cutting, backpedaling or jumping for a basketball player. A rehabilitation protocol isn’t designed to simply get someone back in the game, but to have them return pain and swelling free and stronger (with a decreased chance of injury) than before.
Opinions differ throughout the medical community on the benefits of bracing and taping. Some swear by it, insisting even that all athletes be taped prior to activity, regardless of medical history. Others only offer it to those with previous ankle injuries as a sort of back up support for their possibly “weak” ankles. Bracing and taping will provide additional support to the ankle joint, but that may cost some range of motion, and it is not a 100% guarantee there will be no injury. No matter the personal opinion, bracing should never be a substitute for consistent strengthening exercises.
Should you unfortunately sprain your ankle, you should always follow up with a health care professional; such as your team or school’s Athletic Trainer. Remember R.I.C.E as your initial treatment, and exercises to decrease swelling can start relatively early depending on the grade of sprain. Ankle sprains can be a real pain, but with proper initial and follow up treatment you can limit your time on the sideline.