Ankle Sprains: What You Need to Know
An ankle sprain is one of the most common musculoskeletal injuries, with about 40% of all sprained ankles happening during sports. It is also one of the most painful! Ligaments are big sensory receptors (read in here “pain” receptors), so if you tear one it really hurts. Just this year an international panel published the latest science-based paper* on what actually works and what doesn’t when it comes to managing your lateral ankle injury (which is the most common type of sprain – and yes there are multiple different types). They reviewed the thousands of papers published and made recommendations for professionals like Physio’s and doctors as to what the best available management options are at the present time.
Here’s a run-down of the key things you need to know if you’ve sprained your ankle:
1. Only about 50% of people who have had an ankle sprain actually seek professional care.
2. Up to 40% of people who have a sprain develop chronic instability (ie ongoing symptoms, recurrent sprains and ongoing pain).
Think about those two key statistics for a minute: about half of everyone who has an ankle injury does NOTHING about it, and about the same percentage end up having chronic problems. It doesn’t take a genius to figure out there might be a problem with the way we approach ankle injuries! Trivialising these common problems clearly isn’t the answer.
Given the above facts, you won’t be surprised to learn my own recommendation along with that of the international expert panel is to seek professional care early (in the first week) after an ankle sprain. If you get an early and accurate diagnosis, and early professional care, then you usually don’t end up with ongoing problems. If you are unsure what to do see your Physiotherapist sooner rather than later and your short and long term outcome is likely to be much better.
In terms of diagnosis, we often asked about “getting a scan”. It might interest you to learn that clinical diagnosis is as accurate as MRI in the hands of a skilled Physiotherapist, with MRI imaging reserved for severe injuries.
The scientifically proven management strategies that actually work can be summarised as follows:
What you can do yourself immediately after your lateral ankle sprain:
1. "RICE": Rest (stop walking around on it!), Ice (for 20 minutes), Compression (via a bandage) and Elevation.
2. See your Physiotherapist as soon as you can afterwards. We can help rule out a fracture and diagnose the grade and severity of the injury. This helps guide prognosis (when you can return to sport for example).
3. Anti-inflammatories are ok in the short term for pain – but Panadol has been shown to be just as good at pain relief in these injuries and has fewer side effects.
Treatments that work for acute pain and swelling:
1. RICE and medication as above.
2. Support via a brace or tape.
3. Immobilisation with or without crutches for a short period depending on the exact injury and its severity. This is where professional diagnosis is essential.
4. Rehab exercise: proprioceptive exercise (using wobble boards or similar to promote better balance, reflexes and help improve the sensation after the ligament – a giant sensory receptor – has been damaged) work the best. This may be supplemented with a short course of manual therapy treatment to restore any lost motion. The rehab is progressed weekly, and results in a faster return to work or sports, quicker recovery times, and prevents chronic instability and pain or recurrent sprains.
Treatments shown to have no benefit (ie avoid these options):
1. Any electrotherapy device (ultrasound, interferential, laser etc).
2. Footwear – your risk of an ankle sprain appears to be the same if you wear high ankle shoes (common in basketball) or normal sneakers.
Treatments that Prevent Recurrence / Chronicity:
1. Rehab exercise (use that wobble board!).
2. Bracing or taping.
The take-home messages from this major review are don’t trivialise your ankle injury. In my clinical experience the "repeat offenders" who develop ongoing ankle problems never do their rehab properly the first time because they trivialise the injury. Seek professional care and follow through with your rehab – it produces great results and isn’t too hard to do. It’s far easier than trying to sort out a chronic or recurrent ankle problem.
Also think about the more widespread ramifications of ankle injuries. Your two small ankle joints take the impact loads running and jumping. Their stability and proprioceptive (sensory) input to the central nervous system helps "set-up" the rest of the leg at heel strike to activate all of your muscles to absorb the shock and stabilise the rest of your limb and spine. There is evidence that failed rehab results in poor strength and activation as far away as the hip (in the gluteals) after an ankle sprain that wasn't treated! So act early in the first week after your ankle injury, get a proper diagnosis and start rehab sooner rather than later.
*Vuurberg et al (2018): Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 52:956.