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Ankle sprains are some of the most common sports injuries, often recurring again and again. In most cases the ankle is rolled outwards, resulting in damage to the ligaments on the outside of the ankle.
It is important to get the correct treatment as soon as possible after injury and then follow a full rehabilitation program to get back to full fitness and ensure the injury does not recur.
Symptoms may vary from being very mild to very severe. With a mild sprain the athlete will likely be able to continue with training or competition. A very sever injury will result in hospital treatment and take longer to heal than a broken ankle.
The injury usually occurs from a sudden trauma, twisting or turning over of the ankle. Pain will be felt in the ankle joint itself although will specifically be felt on the outside of the ankle when pressing in on the damaged ligaments. Swelling or bruising may be present but not always in the more mild cases. Pain can also be felt on the inside of the ankle from compression of bones and soft tissue.
Sprains are graded 1,2 or 3 depending on severity and a professional therapist will carry out a full diagnosis and assessment which will include range of motion tests and resisted movement tests to determine the structures injured and extent of the damage.
How bad is my sprained ankle?
Recovery time will depend on how bad the injury is.
Grade 1 symptoms will cause only mild pain with little or no instability. There may be some joint stiffness with difficulty walking or running but the athlete is likely to be able to play on. Some stretching or perhaps minor tearing of the lateral ankle ligaments may have happened resulting in mild swelling around the bone on the outside of the ankle.
Grade 2 symptoms will result in moderate to severe pain with difficulty walking. The athlete is unlikely to be able to play on and will limp. Minor bruising may be evident along with swelling and stiffness in the ankle joint. There is likely to be some instability of the joint resulting from moderate tearing of some of the ligament fibres.
Grade 3 sprains usually results in a total or almost complete rupture of a ligament. Severe pain will be felt initially with lots of swelling and extensive bruising. The athlete will experience gross instability of the joint.
The most common is an inversion sprain or lateral ligament sprain where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments and other soft tissues on the outside of the ankle.
The most common damage sustained in a sprained ankle is to the anterior talofibular ligament. This ligament, as the name suggests, connects the talus with the fibula bone. If the sprain is severe there might also be damage to the calcaneofibular ligament which connects the calcaneus or heel bone to the fibula further back towards the heel. This ligament only becomes injured in more severe injuries.
In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues. If possible an X-ray should be done, as small fractures or avulsion fractures where a tendon or ligament pulls a small piece of bone away can occur. Osteochondral lesions which are tears of the cartilage lining the top of the talus bone are also complications of moderate to severe injuries.
Severely sprained ankles may result in complete ruptures of the ligaments along with dislocation and fractures of the ankle bones.
Immediately first aid aims to reduce the swelling by RICE (Rest, Ice, Compression, Elevation) as soon as possible. Cold therapy or ice should be applied for 10 to 15 minutes every hour for the first 24 to 48 hours. Often pitch side therapists will bind the ankle tightly in a compression bandage as soon as the injury has occurred to restrict swelling, although this must be done with caution for only 10 minutes at a time to prevent starving the area of blood resulting in further injury.
Following the initial acute stage of a sprained ankle exercises should begin as soon as pain allows to maintain mobility and build strength and co-ordination or proprioception in the ankle. A full rehabilitation program should be undertaken which should include wobble board exercises.
A sports injury specialist will assess the injury, make an accurate diagnosis and identify any complications. A doctor may prescribe anti-inflammatory medication (e.g. ibuprofen) to help with pain and swelling.
Swelling can be reduced by using compression devices or applying ankle wraps and taping techniques. Specialist cryotherapy devices which apply cold and compression automatically are used widely by professional sports teams.