How to prevent ankle sprains from happening … again

Do you often roll over the same ankle and it always seems loose?
Have you ever wondered that maybe there is a way to change this?
Did you know that 85-90% of untreated ankle sprains will be recurrent, but with correct management after the first occurrence those number of cases  can be brought down to only 35%?

What happens in an ankle sprain? Which structures are involved?

As a result of continued rolling, turning or instability of the ankle, the ability to make rapid adjustments in the position of the foot on uneven surfaces (proprioception) becomes limited. If this happens, the likelihood of a more severe ankle sprain occurring increases.

A sprain is actually a tear that occurs in the outer supportive ligaments of the ankle. As these ligaments are stretched, a critical point is reached beyond which ligaments do not return to their normal elastic function and a tear of the ligament occurs. Sprains can range from the relatively minor to completely torn ligaments where the ankle can be quite loose.

The common diagnosis for pain on the outer side of the ankle is an inversion sprain. This usually occurs when the foot lands in an awkward manner  and rolls inwards, creating stress on the outside ligaments. When this stress is severe enough, an ankle sprain occurs.

There are three major ligaments attached to the outside of the ankle: the anterior and the posterior talofibular ligaments (ATFL and PTFL), and the calcaneofibular ligament (CFL). The ATFL is the most common ligament to sprain due to the mechanics and the limited support at the front of the ankle.

The other type of ankle sprain is an eversion sprain for pain on the inner side of the ankle. This happens when the foot is twisted outwards. The inner ligament, called the deltoid ligament, is over-stretched.

What can I do after spraining my ankle?

If you are unable to put weight or walk on it, you may have a small fracture. It is advisable for you to get it X-rayed. However, if you feel like you simply rolled over the ankle and putting weight on it hurts a little, apply RICE (Rest, Ice, Compression and Elevation) immediately. Head home and avoid walking on it as much as possible. Fill a wet thin towel with crushed ice or with a bag of frozen peas, and apply to the painful area for 10-15 minutes. Do not apply ice directly to your skin for more than five (5) minutes as it can cause cold-burns. Keep this up every 2-3 hours for the first 48 hours. This will help to minimize pain and control swelling in the area, limiting the extent of damage to the ankle.

For the ligaments to heal the ankle needs to be immobilized with either a cast or a boot. For minor sprains a brace can be applied to the ankle. Make sure it is tight enough to stop the swelling from going down into your ankle but not enough to make your toes turn blue. However, remember to take it off at night but put it back on even before you leave your bed. Keep your foot elevated at night by placing pillows underneath the affected foot to give you just enough elevation to sleep pain-free. Foot pumping exercises (continuously bending and pointing your foot out) are also especially useful when the foot is elevated to help push the fluid away from you and back to your heart. Strictly adhere to the RICE regiment for another 2-3 days or until the swelling is about 75% gone.

How do I prevent a recurrence?

If this is not the first time you have sprained the ankle, the bad news is that once a ligament has been overstretched and not taken care of, it loosens and will never go back to its original length. Not only do ligaments hold bones together, but they also part of your balance-control system by sending messages to your muscles (via the brain), telling them how to react to maintain your balance and prevent excessive movement

The basic philosophy of any rehabilitation programme is to retrained your ligaments to sense and send the required balance signals and  strengthen the muscles. This restores and improves the balance around your ankle to help prevent recurring sprains and protect it from the stresses of everyday life.

A physiotherapy rehabilitation treatment programme may include:

1.    Therapeutic ultrasound would be administered to promote healing and decrease in pain.
2.    Soft tissue massage to aid lymphatic drainage and remove any residual swelling.
3.    Individualised exercise programme which may include:
a.     Calf stretch alphabet exercises - moving the ankle in multiple directions by drawing alphabets in lowercase and uppercase motions.
b.    Isometric strengthening exercises, such as pushing against an immovable object (e.g. wall or floor) or with the unaffected foot, can begin.
c.    Balancing exercises such as standing on your affected leg and try to hold your balance. You will probably notice at first that your injured foot is much more wobbly, which will get better with practice.

Finally, your physiotherapist would also work closely with you to plan a proper activity based training programme to get you back to sport or normal daily activities. You can follow this whole recipe for old recurrent sprains.


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