One of the most common injuries is a sprained ankle, and it accounts for 75 percent of ankle injuries. It can happen to athletes, non-athletes, adults, and even children. Ankle sprains make up 10 to 30 percent of all sports-related injuries in young athletes, and it is estimated that 1 million people visit physicians annually to get it treated (Perlman, Leveille, DeLeonibus, Hartman, Klein, Handelamn, 1987). Usually, you sprain your ankle while playing sports or if you walk on an uneven surface. However, even a simple misstep can lead to an ankle sprain. It is essential to understand the various kinds of ankle sprains in order to understand symptoms and know when it would be necessary to visit a doctor.
When your foot twists, rolls, or turns past its regular range of motion, or if your foot lands on an uneven surface with a force much stronger than your usual force, there is a good chance of an ankle sprain occurring. This is because your ligaments stretch beyond their normal range into an abnormal position. A ligament is an elastic band of tissue that assists in keeping your bones, organs, and joints in place. They usually stretch beyond a certain limit before retracting to their original position. However, when a ligament stretches beyond its normal range due to the exertion of additional pressure or the abnormal rotation of the foot, a sprain occurs. In severe cases, sprains cause the tearing of these elastic fibers. A study found that nearly 40 percent of all ankle sprains can potentially cause chronic problems in a person (Bennett, 1994).
A few general symptoms of a sprained ankle include the following:
- Skin discolouration
The common misconceptions of an ankle sprain
There are some common misconceptions relating to ankle sprains and how to treat them. The key to effectively treating an ankle sprain is to be able to differentiate between facts and fiction. The following are some of the things you might have heard about ankle sprains and their treatment.
Power through the pain
In cases of sprained ankles, some people have the ideology that powering through the pain will make them tougher and more resilient towards injuries. That is not the case. Repeatedly using an injured ankle will hinder your recovery and will probably weaken your joints and possibly further stretch, weaken, or even tear the injured ligaments in your ankle. Therefore, this continuous use increases the chances of converting a minor ankle sprain into a much more severe condition. Some people also assume that once the pain starts to fade away, they can instantly return to their regular routines and activities. This is also false. Even if the paint is fading, it is strongly recommended that you ease into your routine instead of diving headfirst.
Don’t use your injured ankle
Not using your ankle entirely is the opposite of the powering through the pain philosophy. Whether you need to stay off your ankle and the duration for this depends mainly on the severity of the injury. Depending on the classification of sprain (discussed in more detail below), your physiotherapist will provide you with a plan that effectively treats your individual situation. Physiotherapists will typically advise against sitting around and never using your ankle, even in the most severe cases. You may need to start physiotherapy after the injury and will probably be using your ankle on a limited basis with a certified individual present to guide you. It is also possible that you don’t exert any weight on the injured ankle for the first few physiotherapy sessions. That being the case, avoiding using your ankle entirely may cause stiffness or other similar problems, which will make a recovery through physical rehabilitation a longer process.
Some people are just prone to ankle sprains and can’t avoid them
While it is true that some people are more prone to sprained ankles and similar injuries, the statement that these injuries can’t be avoided is not valid. Some measures that you can take to prevent these injuries are:
- Wearing an ankle brace or patch – If you are more prone to ankle injuries either because of a previous injury or for some other reason. Physiotherapists suggest that you wear an ankle brace or patch before taking part in any strenuous activities.
- Wearing activity-appropriate shoes – It is essential to wear shoes that are in good condition, not worn from the heals, and are apt for whatever activity you plan on doing. For example, if you plan on going for a hike, you should wear sturdy shoes that provide your foot with ample support and protection from rocks and uneven surfaces.
- Maintain a healthy weight – You should exercise regularly and have a balanced diet to maintain a healthy weight.
- Avoid physical activities when exhausted or in pain – Your body needs to be appropriately conditioned for whatever exercise you choose to do. If you are trying out a new sport, you should slowly ease into it rather than going all out. Furthermore, taking part in strenuous activities while exhausted or in pain increases your chances of getting an injury.
- Run on levelled surfaces – When possible, you should stick to running on levelled surfaces to avoid your foot getting twisted or rolling into an abnormal position.
- Make sure your injury has fully recovered – Some people make the mistake of believing that since they have slightly recovered, they can restart their physical routines. Not only is that not true but straining your ankle excessively can lead to more severe problems if you have not fully recovered.
Nonetheless, no matter how many precautions a person takes, it is still impossible to entirely avoid the chances of getting an ankle sprain. People who participate in sports and similar physical activities will always be at risk of getting an ankle sprain. However, these precautions help prevent sprains and lower the severity of the injury.
Misjudging the severity of the injury
Another common misconception is that people believe that the injury isn’t too severe and choose to ignore it. It would be best to never assume that since you were injured while doing something that wasn’t too strenuous or that since you can walk even after the injury, it isn’t too severe. It is necessary to check on your injury to ensure it doesn’t develop into a more severe injury.
Soaking the ankle in warm water
While soaking a sprained ankle in warm water may provide temporary relief, you should not be doing this. This is because warm water increases blood flow in the area which has been submerged. Increased blood flow, in turn, increases the swelling of the area. While warm water can be used in physiotherapy, it is better first to wait for the swelling to go down before attempting to use heat to reduce the pain.
The different classifications of an ankle sprain
There are three types or grades of ankle sprains based on the amount of damage caused to your ankle. These grades are:
- Grade 1 – your ankle may be slightly swollen and will feel a little sore. In this grade, the ligament has been overstretched. However, it has not torn.
- Grade 2 – Your ankle is likely more swollen, and you cannot put your full weight on the ankle. You may also notice some bruising in the affected area. There is a partial tear in the ligament in this grade, which causes some bleeding under the skin. The bleeding is the reason you notice some bruising.
- Grade 3 – You experience severe pain, swelling, and bruising in this grade. Usually, a popping sound can be heard when this happens as the ankle ligament is completely torn. As the ligament can no longer function, you can not support your ankle, and your ankle can’t support any of your weight.
Physicians can diagnose sprained ankles, and sometimes x-rays may be required to make sure there are no broken bones in the ankle or foot. Broken bones can cause similar symptoms to sprain ankles, and once your physician rules them out, they will be able to determine the grade of your ankle sprain based on the amount of pain, swelling, and bruising.
When should I seek medical attention for an ankle sprain?
Usually, a sprained ankle is not an emergency. Though there are instances where minor sprains could be more severe, and improper care or treatment could lead to long-term pain or instability. Some of the key symptoms to look out for when deciding to visit a doctor are:
- Sudden pain or pulling in your ankle when you twist or injure it
- A popping sound when you twist or injure it
- Pain or tenderness in the injured area
- Inability to exert any pressure on the affected ankle
- Bone misalignment
- An open wound or severe deformity
- Have signs of infection, such as redness, warmth, and tenderness in the affected area
- Loss of feeling in your foot
You should also visit your doctor if you cannot take more than 4 steps and the pain does not subside within a day. Your doctor will likely recommend a splint or support while the sprain heals. However, if your foot is immobilised for an extended time, you may need physiotherapy to fully recover and strengthen the muscles surrounding your ankle. Furthermore, if your ankle continues to be troublesome, your doctor or physiotherapist is likely to organize x-rays or other investigations, or both. In extreme cases, ankle sprains may even require surgery.
The R.I.C.E method for injuries
If you have injured your ankle and it’s not too severe, the doctor will likely recommend rest, ice, compression, and elevation (RICE) as one of your treatments. The RICE method is a self-care technique that reduces swelling, speeds up recovery, and eases pain. Many minor injuries can be treated at home with the RICE method. It can be broken down into the following four steps:
Pain is a signal from your body that something is not right. As soon as you experience an injury, you should immediately rest as much as possible for the first 2 days. As mentioned above, do not try to power through the pain, as that can only worsen your injury. You must stop, change or take a break from any activity that may be causing you pain.
Icing an affected area was a tried and tested tool for reducing pain and swelling. You should apply an ice pack (covered with a light, absorbent towel to help prevent frostbite) for 15-20 minutes every two to three hours during the first 24 to 48 hours after your injury.
Gabe Mirkin, the author of the book titled The Sports Medicine Book, where the RICE framework was first introduced, initially recommended icing right after a sprain helped cool the injury and prevent swelling. However, he later changed his recommendation after reviewing research which demonstrated that icing sprained ankles further damages the ligaments by shutting off blood supply to the area. The blood is needed to help the tissue cells heal.
Most medical physiotherapists now recommend skipping the icing part altogether unless the pain is unbearable. Even if you decide to use it, you should keep in mind that it becomes ineffective 24 hours after injury.
This means wrapping the affected area with a medical bandage to prevent swelling. While compressing the affected area, you need to ensure the bandage is wrapped correctly and is not too tight or loose. If the bandage is too tight, it may disrupt the blood flow in the region, and you need to have proper circulation. Some signs that the bandage may be too tight include numbness, coolness, swelling, or increased pain and tingling.
This means raising your affected area above the level of your heart. For ankle sprains, it is relatively simple. You can prop your leg up on pillows while sitting on a sofa. It is usually recommended that you keep your ankle elevated even if you notice the area of swelling subsiding.
Medicines with RICE
Depending on the grade of your ankle sprain, the doctor may also prescribe anti-inflammatory medicines such as ibuprofen or naproxen along with the RICE treatment. These are both over-the-counter and prescription drugs, and you must consult your doctor before taking them.
With these tips, a strain, sprain, or minor injury can be treated effectively so that you can go back to your routine without risking further injuries.
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Perlman M, Leveille D, DeLeonibus J, Hartman R, Klein J, Handelman R, et al. Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study. J Foot Surg. 1987;26:95–135.
Bennett WF. Lateral ankle sprains. Part II: acute and chronic treatment. Orthop Rev. 1994;23:504–10.