September is associated with back to school and with that the start of many sports like football, running, and soccer. Unfortunately, some people will suffer a sports injury. Ankle Sprains are one of the most common injuries; they comprise 14% of all sports related injuries and 50% of soccer injuries. Early treatment ensures a better outcome. Indeed, physiotherapy helps guide the healing process to facilitate a better recovery and prevent re-injury.
The most common mechanism of injury is rolling over on the outside of the ankle which sprains the lateral ligament complex. Athletes will often sprain the ligament when landing from a jump; especially when landing on another players’ foot.
There are three grades of ligament sprain. Patients with a grade one sprain have micro-tearing of the lateral ligament and will usually be able to weight bear after the injury. Grade two ligament sprains are accompanied by more swelling and visible bruising as the ligament fibers are more torn and there is definite instability. Weight bearing is painful, and patients will usually hop off the field or court. They may require crutches for a few days. Grade three tears are significant with marked instability. They cannot weight bear and require crutches. Initially ankle mobility is greatly reduced due to pain. An Xray should be taken if there is marked pain and the patient cannot walk 4 steps immediately following the injury. With some ankle sprains, the torn ligament can pull a small chip of bone off its attachment; this is known as an avulsion fracture and will usually appear on an Xray.
Treatment varies depending on the grade of ligament sprains and the stage of healing. In the acute inflammatory phase, the RICE method (Rest, ice, compression, and elevation) is employed. Taping and bracing are important to provide stability and prevent re-injury. Grade three sprains and severe grade two sprains require an air cast to immobilize and allow healing of the torn ligament. Moreover, crutches are used for protective weight bearing. People often ask if they should be walking on a sprained ankle. I advise people to listen to their body; if it hurts to fully weight bear then use crutches or a cane to reduce the load on the injured ankle. Specific active movement is begun in the first week and progressed to resisted strengthening exercises. Weight bearing is progressed as able. Eventually balance drills, hopping and running are given, usually around the fourth week for grade two sprains. Return to sport should be gradual and use of a brace is recommended.
Grade one ankle sprains resolve fairly quickly, usually in 1-3 weeks. Grade two sprains take 4 to 6 weeks and grade 3 sprains require a few months. The body has stages of healing which dictate our recovery. Scar tissue only starts to be laid down in the second week after an injury and is not strong until 4-6 weeks post injury.
The goal of physiotherapy is to produce strong yet extensible scar tissue, regain normal strength and balance, and ultimately resume sporting activities without pain or dysfunction.
Written by Susan Reive PT
Ottawa Physiotherapy and Sports Clinic, Glebe
