Overcoming Acute and Reoccurring Ankle Sprains
Ankle sprains are unfortunately all too common in sports, especially those involving running, jumping, and sudden changes in direction. An ankle sprain can sideline an athlete for various amounts of time depending on the severity of the injury. Although the extent of the injury is important to consider, a major factor in bouncing back from an ankle sprain is what you do about it after it has happened.
Ankle sprains are often quite painful and result in a quick and obvious inflammatory response which causes redness, heat, and swelling locally. It is not uncommon for bruising to appear hours after injury. Initially, the best course of action is found in the acronym “RICE.” Rest, Ice, Compression, and Elevation help manage the inflammatory process (though not eliminate it) by decreasing the amount of weight-bearing stress placed through the injured joint and soft tissues as well as preventing excessive accumulation of edema around the injured area. As long as there is no suspicion of a more severe injury, PT’s will often encourage a well-tolerated, gentle amount of foot and ankle range of motion as well as gradual progression with weight bearing to lessen the stiffening effect of the inflammatory process.
Once one has given their body adequate rest and the space needed to complete the inflammatory phase of healing, the focus is shifted to regaining full range of motion, strength, and proprioception. Proprioception is your bodily sense of joint position and is tightly related to your balance and postural control when weight-bearing. Right away, it may be a major victory to simply balance on one foot. Eventually, proprioception and neuromuscular control are assessed and addressed as a part of an athlete’s ability to complete more complex, sport-related movements with appropriate control and speed. The right therapy interventions can serve as both a treatment to restore what was lost by an injury and to prevent the recurrence of ankle sprains secondary to a more laxed ankle joint following ankle sprain.
A research article in the British Journal of Sports Medicine discussed a collection of articles evaluating the efficacy of treatment and prevention strategies for acute and recurrent ankle sprains. Physical therapists have a wide array of treatment modalities at their disposal, but must select carefully in order to optimize their time with a patient. This review of the literature showed that in the treatment of acute ankle sprain, strong evidence exists for non-steroidal anti-inflammatory drugs (as directed by your doctor) and early mobilization (movement) and moderate evidence supporting exercise and manual therapy techniques for pain, swelling and function. Exercise therapy and bracing are also supported in the research as a prevention strategy for chronic ankle instability. The review indicates that there is “conflicting evidence” for the use of surgery or acupuncture to manage acute ankle sprains, and no evidence to support the use of therapeutic ultrasound as a treatment for acute ankle sprains.
Many times, fractures can be detected in injuries that seem to fall into the “sprained ankle” category. Fractures need to be dealt with differently. If a suspected ankle sprain has resulted in swelling, bruising, severe pain, and difficulty accepting weight on the injured limb, it may be best to have the injury formally evaluated by a physician first before pursuing movement and exercise.
Doherty, C, Bleakley, C, Delahunt, E, Holden, S. (2017). Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med, 51(2), 113-125.
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