6 quick answer questions to understand what a sprained ankle means
What is an ankle sprain and how does it heal?
It is essential to follow these steps as soon as you sustain the injury and for the first 72 hours
- Rest. Avoid as much as possible to support the foot or to make articular movements of the ankle.
- Apply ice for 20 minutes 2 to 3 times a day.
- It is important not to apply the ice directly on the skin.
- Keep the foot elevated as long as possible during the first 72 hours.
- Apply anti-inflammatory cream
- See a professional to evaluate the injury and the need for an x-ray or MRI.
- A badly healed ankle sprain can become chronic, hence the importance of treating it as soon as the injury occurs.
- The sprains are divided into 3 grades depending on their severity
- Grade 1 sprains are the least damaging and therefore the quickest to recover from.
What to do to recover from an ankle sprain?
- Apply ice for the first 72 hours in periods of every 2 hours apply 20 minutes, it is important that a physiotherapist to assess the injury.
- Start rehabilitation exercises. You can start 72 hours after the injury.
- Before performing the exercises, apply 10 minutes of ice.
- To make stretching of the ankle helping you of your hands to stop the movement of the foot in different directions: plantar flaxion, dorsal flexion,
- Walking barefoot on your heels and then on tiptoe.
- Writing the alphabet with your foot
What is a grade 1 sprain?
A grade I ankle sprain is one that causes an overstretching of the ligament. It causes mild pain including some swelling. Recovery times are around one week. Generally with the application of ice for the first 72 hours, and rehabilitation exercises recovery is fairly quick. Learn more about grade 1 ankle sprain.
What is a grade 2 ankle sprain?
A grade 2 ankle sprain involves a partial rupture of the ligament. Bruising is visible in the area and there is a throbbing pain in the area around the ankle as well as some degree of instability when walking or standing. Localized and moderate swelling.
What is a grade 3 ankle sprain?
A grade 3 ankle sprain involves a complete rupture of the ligament, leading to severe instability of the joint. Very clear visible signs of bruising and swelling. Very sharp pain even without touching the area.
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Badly healed or chronic ankle sprain, how to cure it
This time we will talk about a very interesting topic; the badly healed ankle sprain. For any athlete this joint is crucial, since it is the part on which we support our whole body. For that reason, we have to take care of it a lot and for it we will have to know how it is inside our ankle (its biomechanics, its muscles, its ligaments,...) Thus, we will know how to act in case of injury.
Precisely this is what our future articles will focus on, and we think that for a better understanding it is necessary to address this issue in depth.
You may be interested in: Ankle injuries in athletes: prevention and treatment of tendons.
Now we are going to focus on the ligaments, breaking down the subject in the injuries, causes of the same, prevention, treatment and rehabilitation, in a more exhaustive way.
Getting to know our ankles
The ankle is a joint formed by the distal part of the bones; fibula and tibia; and on the other hand the bone of the foot called talus. The movements that it makes are: thanks to the tibiotarsal joint with movements of dorsiflexion (foot up) and plantar flexion (foot down) and by means of the subtalar joint the more limited movements of inversion and eversion are made. In addition, in the ankle there are stabilizing elements such as ligaments and muscles so that fewer injuries are produced.
What are ligaments?
Ligaments are membranes of fibrous, solid and elastic connective tissue that mainly join two bones in the joints. Being a tissue that is located in the joints, its exposure to injury is much greater due to the amount of movements that occur in them. And more taking into account that it is the area where all our body weight falls. In certain sports disciplines (athletics, team sports,...) it is subjected to large and demanding joint movements that must be taken into account.
Although we know that there are several, we will focus on those ligaments where injuries occur frequently and pain in athletes.
External lateral ligament of the ankle (it is divide in 3, the 2 main ones):
- Anterior (lateral) peroneal astragalar ligament (lateral); this ligament runs along the fibula to the talus. Different studies demonstrate that it is the most injurious. And its tightness increases with the movements in the ankle of plantar flexion, inversion and supination.
- Peroneal calcaneal ligament; it goes from the internal face of the fibula to the calcaneus; it is more elastic and resistant than the previous one. Like the astragalinus, it increases its rigidity with dorsal flexion and inversion movements and decreases with plantar flexion.
- Deltoid ligament (internal); joins the talus and calcaneus to the tibia. It has the shape of a triangle and its rigidity increases with eversion movements (external torsion).
Ankle injuries
Once developed and clarified what are the ligaments and which are the most important, we will speak about the injuries that take place in them. We know that injuries can occur in the soft parts (ligaments and tendons) and in the skeletal part (bones) with fractures.
The most characteristic injury is the ankle sprain. This occurs when ligaments are stretched or torn due to inward or outward displacement of the joint.
There are several classifications of types of sprains, but we will focus on 3 different degrees of severity.
Grade I: Consists of ligamentous stretching.
Grade II: The ligaments are partially torn. The athlete can walk with difficulty due to not being able to support the foot.
Grade III: The ligaments are completely torn. The edema and the pains that are produced are considerable and it extends for the whole ankle, which on the other hand is impossible to support. In extreme cases surgery is necessary, that is why some authors extend the classification and say that there are grade IV sprains.
Causes of the injuries in the ankle
The causes of an ankle injury are multiple General aspects such as poor nutrition, hydration or warm-up (in short, not properly performing the desired and ideal invisible training) can cause an injury.
On the other hand, there are more specific aspects about the different causes of an injury such as:
Athletes above their ideal weight. These athletes should try to lower their weight because it is a burden when it comes to preventing injuries. It is necessary to bear in mind that all our body relies on this articulation.
To know if the athlete has anatomical alterations in the foot. In this way we will have more impact on a good technique of execution.
Therefore we must see that we perform the proper technique so that the ankle does not suffer excessively.
The history of injuries (surgery and previous traumatisms) on this joint to be able to prevent with different exercises.
The material, in this case the footwear, is fundamental. Appropriate footwear avoids many ankle injuries.
To know the state of the facilities, if it is the optimal one to develop our sports practice.
- You may be interested in: Fibrillar rupture in the calf, how to cure it.
Prevention of ankle sprains
Prevention is essential so that an injury does not frustrate us from any competition or training. If we get injured, we will be limiting our training and therefore our sporting goals.
For a good prevention it is important:
- A good warm-up and good stretching (initial and final part).
- Strength work; with the strengthening we will avoid unnecessary sprains (sprains).
- Eccentric ankle work with all the exercises that we can imagine. The eccentric work are braking movements, in which the work done by the ligaments is excellent.
- To work the proprioception of the ankle; the objective of this section is to create instabilities so that the day of the training or the day of the competition, when some incidence happens to us (slip, bad tread,...) we are totally prepared. The bosu is a material widely used for this type of work.
- Work 2 ankles so as not to create decompensations and that one ankle is much stronger than the other.
Finally, if a good ankle massage is necessary for different circumstances, it is done without any problem. Your physiotherapist will know what is ideal.
Treatment of ankle sprain
The treatment to cure an ankle sprain is very important, since it is an injury with a high risk of relapse in a short time if it is not well healed. That is why it is essential to treat the sprain well.
In the initial treatment of an ankle sprain is the same for all different degrees of injury and is:
Application of ice, especially if the swelling is considerable because it limits the mobility of the joint.
Relative rest and elevation to eliminate the load on the joint. But we must perform active and passive activities.
Perform different strength and proprioception exercises to strengthen the ankle and prevent further injury.
To make a compression of the ankle with a correct bandage. The compression will depend on the degree of the injury.
Treatment grade 1 sprain:
Its duration is usually one week, as long as the correct steps are followed in its treatment. With the application of cold and a functional bandage, this type of sprain heals without problem.
Treatment grade 2 sprain:
We must protect the damaged ligaments with an appropriate functional bandage. In addition, a circulatory massage and manipulation by the physiotherapist should be performed (depending on the characteristics of the sprain). An element that helps to reduce the injury time is the electrostimulation and apply the prevention points included in the previous section.
At a general level the duration for a good recovery is approximately 3 weeks, but for this it is necessary to follow the indications of the professionals.
Treatment of grade 3 sprain:
The treatment of grade 3 sprain is similar to that of grade 2, but obviously the terms are going to be increased. In addition, total immobilization is recommended for the first few days so as not to affect the recovery time. It is difficult to define how long recovery takes due to the individual characteristics of each athlete and each injury. Sometimes, and from the point of view of some authors, grade 3 sprains should be treated surgically. In our opinion, this should be the last resort.
Rehabilitation of ankle sprains
During ankle rehabilitation, all the preventive exercises described above are used.
On the other hand, in articles such as the one written by Gomez, J. in 2013, we discovered 3 different phases for ankle rehabilitation and strengthening. First we focus on the mobility of the joint to subsequently, and progressively, move forward with proprioception and strength exercises.
1st phase: passive mobility exercises: with full mobility of the ankle and a lot of stretching (without pain).
2nd phase: active mobility exercises: this phase begins when the pain is completely eradicated. Isometric exercises of inversion, eversion, plantar flexion and dorsiflexion (with different series and repetitions) are performed. In addition to toning exercises with rubber bands.
3rd phase: proprioceptive exercises without material and with material (in progression).
Also authors such as Andújar, C., García F. and Pérez M. Á. in 2010 propose different ankle rehabilitation programs, for example;
- Posterior tibial strengthening program.
- Mainly with the exercise of resisted foot adduction with elastic band footwear.
- Selective strengthening program of the tibialis posterior and stretching of the triceps suralis.
- Resisted foot adduction exercise with elastic band footwear.
- Triceps suralis stretching exercise (calf and soleus).
- Soleus soleus stretching exercise.
- Personalized program.
- Strengthening exercises
- Resisted foot adduction exercise with elastic band footwear.
- Ankle inversion exercise, with heel support, resisted with an elastic band.
- Unilateral heel lift exercise.
- Stretching exercises
- Standing triceps suralis stretch facing a wall.
- Soleus soleus stretch standing in front of a wall.
- Standing triceps suralis stretch on the edge of a step.
Success lies in prevention
To conclude, we believe that it is essential for an athlete to know what injuries can occur in any sport. In this way, he/she will be able to prevent a greater percentage of injuries. Although it is impossible to reduce the risk to 100% because there are random factors, it is important to reduce that percentage as much as possible. This is achieved through preventive measures (discussed in the previous article).
At the same time, it is very important to put yourself in the hands of a good professional, that is, your physiotherapist and/or osteopath to give you the best sessions, activities and exercises that you should perform for your recovery.
From Runnea we advocate an individualized and progressive treatment of each injury, because thanks to this the results will be as expected by the athlete.
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