Friday, July 11, 2014

Ankle sprain or twisted ankle

A sprained ankle or twisted ankle is a common cause of ankle pain.  
More common is an inversion sprain (or lateral collateral 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 lateral collateral ligament comprises of 3 bands connecting the fibula anteriorly and posteriorly with the talus and with a 3rd band on the sides with the calcaneum. Severe the injury more the no. of bands injured.

In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, that is why it is important to get a professional to diagnose your ankle sprain.

                                          Grades of Severity for Sprained Ankles:

Sprained ankles, as with all ligaments sprains, are divided into grades.

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.


                                                         Treatment of a Sprained Ankle

Immediate First Aid for a sprained ankle:
Aim to reduce the swelling by PRICE as soon as possible.

P is for PROTECTION. The injured ankle should be protected with utmost care to prevent any further injury.

R is for REST. It is important to rest the injury to reduce pain and prevent further damage. Use 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.

E is for ELEVATION - Uses of gravity to reduce bleeding and swelling by allowing fluids to move away from the site of injury.

Further treatment

In cases of severely injured ankle (grade 2 and 3) cast can be applied for 3-6 week as per the orthopaedics decision. At times surgical intervention may be needed.

Following the initial painful stage in grade 1 treated with PRICE and after removal of cast in severe cases, physiotherapy treatment can help the ankle return to normal as soon as possible.

Physiotherapeutic modalities like LASER therapy, Ultrasonic therapy and TENS can help reduce pain further and promote healing. Hot fomentation can increase the circulation of the area which further promote healing and increase the pliability of the tissues. Wax bath instead of hot fermentation can be used in cases where cast was applied. 

To strengthen the soft tissues around the ankle start with gentle isometric (tension building without movement) exercises, followed by range of motion exercises within the painfree limits. As for e.g.. writing the alphabets A-Z with the great toe on the floor, heal raises in sitting etc. Approach your physiotherapist to learn more.

Strength can be further developed though resisted exercises with the help of therabands.

The techniques like cross frictional massage and ligament stretching can be implemented to prevent adhession formation and to maintain the flexibility of the ligaments. This helps to reduce the chances of recurrent ankle sprain problems.

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.

A wobble balance board is an important part of rehabilitation of ankle sprains to improve the proprioception (joint sense) which generally gets hampered after any injury.

Contact Pain Free Physiotherapy Clinic for Physiotherapy treatment of ankle sprain.

Dr. Roshan Jha (PT)
Sr. Physiotherapist 
Pain Free Physiotherapy Clinic
31 A, DDA Flats, Pocket 2, Sector 6, Dwarka
Ph. No. 8800299652