Sprained Ankle

What is a sprained ankle? A sprained ankle or twisted ankle as it is sometimes known, is a common cause of ankle pain. A sprain is stretching and or tearing of ligaments (you sprain a ligament and strain a muscle). 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 on the outside of the ankle. A medial ligament sprain is rare but can occur particularly with a fracture. This happens when the ankle rolls the other way, so the sole of the foot faces outwards, damaging the ligaments on the inside of the ankle. The most common damage sustained in a sprained ankle is to the anterior talofibular ligament shown towards the front of the image opposite. This ligament, as the name suggests, connects the talus (ankle bone) with the fibula (smaller of the two bones in the lower leg). If the sprain is severe there might also be damage to the calcaneofibular ligament (connects the heel bone to the fibula) which is further back towards the heel. This ligament only becomes injured in more severe injuries due to its increased strength and laxity whilst the toes are pointed (a common position for ankle sprains). In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, which is why it is important to get a professional to diagnose your ankle sprain. If possible an X-ray should be used, as small fractures are not uncommon. Severely sprained ankles, where there are complete ruptures of the anterior talofibular, calcaneofibular and posterior talofibular ligaments, result in dislocation of the ankle joint which are often associated with a fracture. Grades of Severity for Sprained Ankles : Sprained ankles, as with all ligaments sprains, are divided into grades 1-3, depending on their severity: Grade 1 sprain: Some stretching or perhaps minor tearing of the lateral ankle ligaments. Little or no joint instability. Mild pain. There may be mild swelling around the bone on the outside of the ankle. Some joint stiffness or difficulty walking or running. Grade 2 sprain: Moderate tearing of the ligament fibres. Some instability of the joint. Moderate to severe pain and difficulty walking. Swelling and stiffness in the ankle joint. Minor bruising may be evident. Grade 3 sprain: Total rupture of a ligament. Gross instability of the joint. Severe pain initially followed later by no pain. Severe swelling. Usually extensive bruising. Treatment of a Sprained Ankle Treatment of a sprained ankle can be separated into immediate first aid and longer term rehabilitation and strengthening. Immediate First Aid for a sprained ankle: Aim to reduce the swelling by RICE (Rest, Ice, Compression, Elevation) as soon as possible. R is for rest. It is important to rest the injury to reduce pain and prevent further damage. Uce crutches it necessary. Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate rehabilitation. I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (when used later). Apply an ice pack or similar immediately following injury for 15 minutes. Repeat this every 2 hours. C is for compression - This reduces bleeding and helps reduce swelling. A Lousiana wrap bandaging technique is excellent for providing support and compression to a recently injured ankle. E is for Elevation - Uses gravity to reduce bleeding and swelling by allowing fluids to flow away from the site of injury. So put your feet up and get someone else to wait on you! Following the initial painful stage, there are other treatments that can help the ankle return to normal as soon as possible. Range of motion exercises such as ankle circles can help to get the ankle moving again, as well as reducing swelling if performed with the leg elevated. The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint. What can a Sports Injury Specialist do about it? A sports injury specialist will undertake a thorough assessment of the injury so time is not wasted treating the wrong condition. A doctor may prescribe anti-inflammatory medication (e.g. ibuprofen) to help with pain and swelling. Reduce swelling by compression devices or taping techniques. Use ultrasound and laser treatment to reduce pain and inflammation and promote healing. Use cross friction massage to promote healing and reduce scar tissue development. Prescribe a full ankle rehabilitation programme to strengthen the joint and help prevent future ankle sprains.

sprain and a strain

What is the difference between a sprain and a strain?
A sprain is an injury to a ligament. A ligament is a thick, tough, fibrous tissue that connects bones together. Commonly injured ligaments are in the ankle, knee, and wrist. The ligaments can be injured by being stretched too far from their normal position. The purpose of having ligaments is to hold your skeleton together in a normal alignment -- ligaments prevent abnormal movements. However, when too much force is applied to a ligament, such as in a fall, the ligaments can be stretched or torn; this injury is called a sprain.

A strain is an injury to a muscle or tendon. Muscles move your skeleton in an amazing variety of ways. When a muscle contracts it pulls on a tendon, which is in turn connected to your bone. Muscles are made to stretch, but if stretched too far, or if stretched while contracting, an injury called a strain my result. A strain can either be a stretching or tear of the muscle or tendon.

What causes a sprain?
As said earlier, a sprain is caused by a ligament being stretched too far. A common sprain is an injury we often call a 'twisted ankle.' This injury often occurs in activities such as running, hiking, and basketball. People will fall or step on an uneven surface (in basketball this is often another player's foot) and roll their foot to the inside. This stretches the ligaments on the outside of the ankle, called the talofibular and calcaenofibular ligaments.

Sprains are commonly graded according to the extent of the injury. Grade I and Grade II ankle sprains can usually be treated conservatively with treatments such as icing and physical therapy. Grade III ankle sprains can place individuals at higher risk for permanent ankle instability, and an operation may be a necessary part of treatment.

What causes a strain?
Strains are injuries to muscles or the tendons that attach the muscles to your bones. By pulling too far on a muscle, or by pulling a muscle in one direction while it is contracting (called an 'eccentric contraction') in the other direction can cause injuries within the muscle or tendon. Strains can also be caused by chronic activities that develop an overstretching of the muscle fibers.

What activities are common causes of these injuries?
Many sports place participants at risk for sprains and strains; these include football, basketball, gymnastics, volleyball, and many others. These injuries also often occur in normal everyday activities such as a slip on ice, a fall on your wrist, or jamming a finger. Repetitive activities may also cause a sprain or strain.

While not all sprains and strains can be prevented, a few helpful tips can help you avoid this nuisance of an injury:

• Stretch before you workout
• Wear proper footwear for the activity
• Warm up properly before activities
• Do not run on icy or uneven surfaces

What are the symptoms of strain or sprain?
The symptoms of a sprain are typically pain, swelling, and bruising of the affected joint. Symptoms will vary with the intensity of the injury; more significant ligament tears (Grade III injuries) cause an inability to use the affected joint and may lead to joint instability. Less serious injuries (Grade I injuries) may only cause pain with movement.