What to do when you sprain your ankle?

Ankle sprains are pretty common. Many of us have had one and if you had one, there is a good chance you will have or had a second one. You step off the curb, step wrong just for one second, and bang, your ankle goes out of under you.

Inversion ankle sprain with strong hematoma

Not a pretty sight!

What is an ankle sprain?

The most common ankle sprain is the inversion ankle sprain. The sprain is graded into 3 different categories.

  • Category one leads to some stretching or minor tearing of the ligamentous fibers. The joint stability is usually not compromised. You might feel the joint to be a little bit more stiff, but usually there is not a lot of swelling, and only mild pain.
  • The second degree sprain is a different matter. The joint is definitely more unstable, there is more tearing and separation of ligamentous fibers.
  • The third grade involves a total rupture of the ligament and severe instability of the joint, profuse swelling and severe pain. A third degree sprain can be accompanied by other ligament or structural injuries  in the joint. and surgery might be necessary.

What to do at first?

RICE – rest it, ice it, compress it and elevate it is probably the most important thing to do in an ankle injury initially. Depending on the severity of the sprain you might have to have the ankle immobilized for a couple of weeks, or even have surgery (usually 3rd degree sprain).

What to do later?

Here comes my disclaimer, I am not a physician and don’t try to be one. This advice is not for you to treat yourself but be a little bit better informed. It certainly does not replace your healthcare professional.

In the beginning you will have to scale back on vigorous training (that is at least what the textbook says). Well, you have other body parts you can work out vigorously without compromising joint integrity. You will have to lay off of running, jumping or some leg exercises but don’t think you can get out of working out once you are past the first 3-5 days. Once you are allowed to be weight bearing again you can even try some aquatic exercises which allow you to be partially weight bearing, and you have some compression from the water on the joint. Neat trick!

Now if you only have a minor ankle sprain you don’t have to go into the pool to exercise. You will want to stay initially with bilateral movements that minimize eversion or inversion of the foot. Avoid forcing range of motion. Stability seems to be the key. Pain should be the guidance and you want to progress to range of motion exercises as quickly as possible. Later on it is important to maintain the appropriate range of motion via mobility work.

Training balance as soon as it is painfree can help stabilize the joint against future injuries. Some people question the use of balance boards, bosu balls, etc. with the argument that they defy the argument of specificity. The next step would be the transition from walking to running, lateral movements with stabilization and finally cutting and sport specific exercises. Strength training should be functional and look at the whole body not just the ankle joint. Gait analysis and corrections should be made and progressions should be dependent on owning the movement. Pain should be seen as an indicator to back off.

Take Away

Stage 1

  1. RICE (rest, ice, compression, elevation)
  2. Exercises stressing plantar and dorsiflexion (pointing your foot and pulling the foot back)
  3. Cycling and hand ergometer

Stage 2

  1. Range of motion in all planes
  2. reduce swelling and pain
  3. Balance exercises

Stage 3

  1. Full strength
  2. Full range of motion
  3. Restoration of proprioception
  4. Reintegration into sports

Rehab nowadays does not reduce you to one join anymore, at least it should not. Your training should still be challenging but take into account that your ankle is a problem. Pain is always the guidance. Pain changes movements and innervation patterns. Just because you are able to still do the movement clean with pain, does not mean that the muscle that the integrity of the kinetic chain is still given. Unilateral strength exercises are functional and add stability to your strength training but initially after returning to your strength training you might have to regress back to bilateral work in order to really focus on strength. If you look at the make up of a training session it would look something like this:

  1. Foam Rolling
  2. Mobility work as allowed
  3. Ankle stability training
  4. Strength training
  5. Conditioning

I hope this has been helpful,

Have a great start into the weekend,

Michael

 

References:
Cressey, Eric (6/23/2014 online) http://www.t-nation.com/training/bosu-ball-the-good-bad-and-ugly/print
Prentice, William E. (2004).  Rehabilitation Techniques for Sports Medicine and Athletic Training
Peterson & Rendström (2001). Verletzungen im Sport. Prävention und Behandlung. 3. Auflage. Deutscher Ärzte-Verlag.
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