An ankle sprain is probably the most common injury sustained by both active, and non-active populations. Ankle sprains generally occur at a definable point in time, where the ankle is rolled over (usually to the outside). This causes damage to the ligaments at the outside of the ankle. This is known as either a lateral (location of the injury) sprain or an inversion (the movement causing the injury) sprain.

Injuries where the ankle is rolled inwards can occur, although are far less frequent. This is because the joint and the surrounding ligaments are more stable on the inside. This type of sprain is termed an eversion sprain or medial ankle sprain.

All sprains (be it ankle, knee, elbow, finger etc!) are graded 1-3 depending on the amount of damage caused. A grade 1 injury is a minor sprain, where less than 10% of fibres are torn. A grade 2 sprain consists of considerable damage (often called a partial rupture) and a grade 3 is a complete rupture.

There are three main ligaments on the outside of the ankle. The most commonly injured is the Anterior Talofibular (ATF) ligament and damage may occur to just one ligament, two or all three. A complete rupture of all three ligaments results in dislocation of the ankle joint.

Following a suspected ankle sprain it is always important to get an x-ray to rule out any associated fractures. Fractures such as avulsions (where the ligament pulls part of the bone away) are common in moderate to severe ankle sprains.

Treatment of ankle sprains should always involve immediate rest, taking the weight off the ankle and using ice, compression and elevation as soon as possible. A common mistake is to ice once only. In reality, ice should be applied for 10-15 minutes at a time, every 2-3 hours for the first 48 hours to help reduce swelling and inflammation.

Normal weight bearing should be encouraged as soon as possible (within the limits of pain) to help the ligaments to heal in the correct orientation. Other mobility exercises such as ankle circles can be introduced from day one to help maintain movement and reduce swelling (if performed in an elevated position). Calf stretches should also be used as soon as possible.

Once weight bearing has been achieved, start to add resistance band exercises into dorsiflexion (pointing the foot up) and plantarflexion (pointing the foot down) to improve strength. Later on calf raises and exercises into inversion & eversion can be introduced.

One important part of ankle sprain rehabilitation not to forget, is balance re-training, or proprioception. You may have seen people using wobble boards or cushions to balance. These can be used with great effect in a sprained ankle and are vital in trying to prevent the injury occurring again.

For more on ankle sprain injuries and rehabilitation visit www.sportsinjuryclinic.net

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