Ankle sprain, why, how, what to do?
Doctor Auquier, sports doctor in Brussels and Ottignies and Thomas Clarebout, give us more information on ankle sprain.
1) What is an ankle sprain?
An ankle sprain is a traumatic distension, even a tearing of the ligaments of the ankle. A ligament is a fibrous band that extends from one bone to another and provides stability to the joint. The trauma can involve all the ligaments of the ankle. We speak of an external sprain when one of the three bundles of the external lateral ligament is affected. Depending on the number of bundles affected: one, two or three, we speak of a grade I, II or III external sprain. When the internal ligament is affected, it is called an internal sprain. This is much rarer. Finally, the anterior ligament which extends from the fibula to the tibia can rarely be distended. We then speak of a sprain of the syndesmosis. If the trauma is more or less violent, ligament injuries can be joined by fractures or bone tears, but also tendon injuries.
2) What is the mechanism of injury?
The sprain occurs during a sudden twist of the ankle, the foot inside causing an external sprain (most often) or outside causing an internal sprain (more rarely). During the trauma, the foot may be more or less in plantar flexion. A bad landing after a jump, the wrong foot when jogging on uneven ground are the two most common causes of sprains.
3) I sprained myself, should I automatically go to the emergency room?
If one is able to walk without acute pain, one should not automatically go to the emergency room after a sprain. It should be known that the importance of the swelling is not a criterion of severity of the ankle. By a careful clinical examination the physiotherapist or the sports doctor will be able to say if there is a fracture with a degree of certainty of 99%. These review rules
are grouped together in the so-called Ottawa protocol, which has been proven scientifically for many years and which makes it possible to avoid many unnecessary and costly x-rays.
In an emergency, what should be done is to put a compression bandage around the ankle, possibly to elevate the limb. Do not take anti-inflammatories or aspirin, which prolong healing times. In case of significant pain, paracetamol alone is sufficient.
In 2020, we are increasingly questioning the application of ice which, if it reduces pain, could also slow the healing of lesions.
4) I have repeated sprains, what can I do?
Repeated sprains sign instability of the ankle. Protocols for muscle strengthening and balance training and ankle reflexes exist and are put into practice by physiotherapists and physical trainers. Sometimes and depending on the type of sport, podiatry insoles can help stabilize the ankle. Taping has shown its full effectiveness if applied before sports practice. It even seems more effective than commercial splints.
5) Is surgery an option?
Surgery is very rarely used. During an acute trauma, it will be used in the event of a displaced bone fracture of the malleolus. In the case of chronic instability, it may be considered in the event of failure of the conservative treatments described in the preceding paragraph.
Thomas Clarebout, Sports physiotherapist at Uperform Diamant, gives us more information on the rehabilitation of a sprained ankle.
6) Why is treatment by a physiotherapist necessary, regardless of the grade of ankle sprain?
Recurrence is the major risk of ankle sprain, even if the latter is benign (grade 1). Indeed, the relapse rate is particularly high and can reach 70% among athletes. The physiotherapist plays a key role in preventing these recurrences. To do this, he accurately assesses the associated lesions and takes care of them.
The foot-ankle complex is not reduced to one joint, it is linked to a multitude of joints, all connected. It is therefore essential to adopt a global approach and, if necessary, take charge of all the lesions. These represent the main risk factors for recurrence in the event of no rehabilitation, poorly conducted rehabilitation or early recovery.
I allow myself to insist on the importance of physiotherapy care, regardless of the severity of the sprain. It must be done as soon as possible in order to overcome any possible complications and speed up the healing process.
7) How does rehabilitation work?
If the goal is obviously to come back as soon as possible, any healing is governed by many inflammatory and physiological processes that we cannot fully control. It is therefore essential to do everything possible to stimulate the healing process, but patience and listening to your body are two other essential aspects. Ankle sprain rehabilitation goes through several phases, each with its own goals.
The first phase, called inflammatory, is the one that appears from the first days following the accident. The foot-ankle complex is then often swollen, sometimes bluish depending on the severity, and walking is painful. During this first phase, the primary goal is the reduction of pain and the disappearance of swelling.
8) Will I get back to my pre-injury level?
We want you to forget your injury and restore your confidence in sports, but at UPerform, our goal is also to improve your performance! So why not take advantage of this forced downtime to work on your weaknesses, such as lumbar mobility or upper limb strength? Your immobilization of the ankle does not mean the total stoppage of the rest of the body, quite the contrary! Thanks to individual and gradual support, we will strive to aim for performance. You set your own goals and we seek to achieve them. Do you want to increase your running perimeter, run faster or longer? A personalized training program awaits you!
9) What can I do to speed up the process?
To help speed healing and prevent future sprains, you will be asked to perform exercises at home daily. So that you are real actors of your rehabilitation!
These specific exercises will be seen and discussed with your reference physiotherapist because each rehabilitation is different and requires personalized care. This home training program will include both mobility, strengthening and proprioception (balance) exercises as well as a gradual return to running or any other physical activity that requires your ankle. In case of doubt, we will be there to guide and facilitate your rehabilitation!