sprains are one of the most common sports medicine injuries.
The ankle is stabilized by 3 ligaments on the outside - the anterior talofibular,
calconeal fibular and posterior talofibular ligaments (see figure-1st panel,
and by a fan-like ligament in the inside-the deltoid ligaments)
injuries (turning the ankle inward, strain the outer ligaments, while eversion
injuries will sprain the inner deltoid ligament. Sprains are classified by degree
1st degree sprains involve stretching of the ligaments but not tears.
There is minimal swelling and instability. Usually the patient may resume sports
within a few weeks. This is most common in ankle injury.
2nd degree injuries involve tearing of ligaments with more swelling and
bruising. This may take 3-8 weeks to return to sports.
3rd degree injuries involve severe tears of the ligament (yet surgery
is rarely required). Because the ligaments are torn it may take 8-12 weeks to
heal. Laxity and instability can result of this injury. Many injuries with incomplete
tears fall between 2nd and 3rd degree tears.
Treatment of Ankle Sprains
The first thing to do is accurately diagnosing an ankle sprain and not missing
other serious fractures that require other treatment.Any
injury that is very painful or unable to walk on should be suspected as a fracture
and be seen by a doctor. The severity of the injury should dictate the treatment.
Even a severe ankle sprain should be kept splinted and on crutches (even if
no fracture is seen on the x-ray) since this treatment will also help them heal.
Stage 1 - Inflammation (3 days) It is important to
rest and splint the ankle. PRICES or Protection, Rest, Ice, Compression, Elevation
and Support, will help decrease the pain and swelling associated with the acute
injury. An anti-inflammatory drug may be used as well. That will treat both
the inflammation and the pain.
Stage 2 - Early mobilization and strengthening (up to 1week) This involves
walking on injury (assisted with crutches for partial support if needed). Taping
or a brace will also give support. Early exercises to maintain range of motion
Stage 3 - Rehabilitation This involves improving ankle strength, flexibility,
and balance. Physiotherapy or athletic therapy is important (this may begin
on the 2nd week)
Stage 4 - Late Rehabilitation It is important to ensure that the ankle
is adequately strong enough to allow return to sport.
Some advocate 'over-rehabilitation' which refers to the continuing of stretching
and exercise programs at home to ensure that this same injury will not reoccur.
Often making the athlete stronger than they were before the injury.
Forms of Treatment
Crutches - should be used whenever the injury is very painful to walk on.
Gradually crutches may be used less as the injury heals, by allowing more weight
to rest on the foot.
Athletic Taping - supportive athletic tape is applied to the ankle to
give support. The tape must be applied by an experienced therapist and not left
on overnight as it can interfere with circulation.
Ankle Braces - commercial over-the-counter braces give similar support to
taping but may be easily applied by the patient and are reusable. They may also
be used continually to prevent future ankle injuries.
Ankle braces such as "aircast" or equivalent are useful in limiting the injured
ankle motion to an up and down plane (dorsiflexion/plantar flexion) but preventing
any rolling over. This allows a quicker return to normal activities without
re-injuring the injured ankle.
As mentioned earlier, anti-inflammatories are used at the onset to control
inflammation and pain. They are also of benefit later during rehabilitation.
Analgesics such as Tylenol (acetaminophen) give pain control but not ant-inflammation.
Glucosamine is a herbal agent that although slower in onset, has anti-inflammatory
Corticosteroid injections are sometimes used in chronic injuries that still
have significant pain and swelling but are not used for fresh injuries.
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