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June 8, 2015
The Dreaded Sprain
Ankle sprains are common. especially in a young athletic population. I find it interesting that many people underestimate the length of time and discomfort involved in this injury. Probably due to the fact that the word "sprain" doesn't mean "broken," many folks just simply get frustrated when after several weeks of pain and swelling, the ankle continues to bother them.
Ankle sprains are microtears of the ligaments that support the bones of the ankle. Those on the outside of the ankle are most commonly injured, as the foot turns inward on an awkward landing. Tenderness, swelling, discoloration and stiffness are the classic symptoms. Ankle fractures are usually differentiated by palpation, as the bone generally is not painful. But, falling on an inward-turned ankle will often create a loud 'pop,' pain that brings near-fainting, and immediate falling to the ground to prevent further pressure on the ankle. Severe ankle sprains, I am convinced, hurt as bad as some ankle fractures.
The old adage, RICE, is still the standard of care. Rest, ice, compression, and elevation can make great headway in getting over an ankle sprain. Oftentimes, an individual will continue to be upright and walk on the extremity in the following days, and still cannot understand why the ankle swells. Ice is good in this instance, and Ziploc bags with ice/snow and water are excellent at about 30 minutes every hour, a few times a day. An Ace wrap lightly wrapped helps prevent marked swelling as well.
Treatment and rehabilitation goals involve early range of motion, and partial weight-bearing with crutches. We recommend gentle range of motion of the foot up and down, and after about five days start turning the heel in and out. Flexibility of the calf muscles should be maintained by facing the wall with one foot in front on another. Lean forward with both hands on the wall, and keep your heels on the ground. Then switch foot positions and repeat.
Once most of the range of motion has returned, start working on strength restoration using a section of innertube or rubberband. Sit on the floor, and with the tube tied to a chair or the door, pull against a loop in the tube with the forefoot by pointing your toes to your nose. An opposite effect can be achieved by holding the tube and pushing away with your foot like stepping on a gas pedal.
Warming the ankle in warm water can be an advantage, as this will allow more flexibility in the joint. Use ice after the exercise to minimize further swelling or irritation to the soft tissue created by the exercises.
Athletes can usually return to sports when full range of motion, strength, and strong balance have been achieved. Often, early attempts at sports create chronically painful conditions, and recurrent ankle sprains are about as welcome as a skunk at a lawn party. So, be smart, be patient, and treat these with the respect they need, and sprained ankles can be a minor problem. Sometimes, taping and braces are used, and it usually isn't a bad idea, especially if one is playing a high risk sport for such injuries.