How to prevent ankle sprains from happening … again

Lateral View of the Ankle
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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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Creative Commons LicenseThis work by Core Concepts - Musculoskeletal Health Group is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License. This article was contributed by Singapore's Largest Physiotherapy Group - Core Concepts. In the spirit of promoting health education, you may copy, distribute and transmit the work under the conditions specified by the license. For articles re-printed with permission, copyright remains with the original copyright holder (author or publisher). Core Concepts's Creative Commons License does not apply in such cases.

Comments

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  • Katie

    I think that it is hard to hurt your ankle again. I tore all three of my ligaments in my right outside of my ankle. I had to have a boot and crutches for 4 weeks. Than I had hurt it again in my second period p.e class so I had to go back to the doctors. The day i got my cast and crutches was the day I got a black eye by a girl. After I had gotten back to school we all had an assembily and after the assembily I had fell down a flight of stairs and only 1 person had helped me up. But still I hurt it and I have an ankle brase but it seems like it does not work. So my advice to everynoe who hurts their ankle by tearing the ligaments is take the correct percautions and ice.

  • Pingback: Eccentric ankle evertor muscle strengthening is better than concentric strengthening after a lateral ankle sprain : Musculoskeletal Consumer Review

  • Iris

    I’ve sprained the same ankle 7 times.  Man that hurts sooo bad every time.  Last time I was just walking (in flat shoes on a flat sidewalk and somehow it slipped and I sprained it again.  I’m seriously thinking about just keeping a permanent ankle brace on.

  • Martatavrego

     the best you can do is to go to a physiotherapist in order to treat the ankle sprain and prevent it from happening again, if you constantly use a brace or tapping material on it, it  will actually worsen in long term because the use of it decreases the activity of the peroneous longus, which is a very important muscle to stabilize your ankle. My advise is to do a long term proprioceptive training, as well as strengthening, Best Regards,Marta

  • Kieven

    I sprained my right ankle many months ago from street soccer. This week, starting Monday I have been playing soccer everyday and have sprained my left ankle on the first day(minor enough for me to continue playing). The day after that I hurt the same ankle two more times but continued playing. Today(Wednesday) I sprained my right leg pretty badly, but with ankle guards, the pain went down after 15 minutes and I continued playing albeit with minimum movement(as a defender). It is now midnight and I’m researching ankle injuries….because I’m gonna play again tomorrow, unless it’s unbearably painful. What should I do in terms of rehabilitation exercises(e.g balance exercises?)?

  • JVD

    You should take some rest and not play soccer for some time. If you gonna keep on playing and hurting your ankle again and again, it will only get worse in the long run. Give it some time to properly heal.

  • ColenenEyman

    I pulled my ligaments in my ankle when I was young and they did not tell me to let it heal for 6 weeks and I did again a week later. Now I have rolled it at lets 10 times. I have been playing indoor soccer and have rolled it 3 time in the last 6 months but this last time it had a very load pop. i don’t know what to do but can tell it will roll very easy.

  • Jillian

    I play basketball and sprained my ankle many times. Using rest and ice only made my ankle significantly weaker and took too long to heal. If you cannot go see a physical therapist, a good at home alternative is the H.E.M. Ankle Rehab program ( http://hemanklerehab.com ). It worked quite well for me by improving the recovery time to about a week and increasing strength and stability in my ankle without needing to use an ankle brace any longer. Thanks for the helpful article!