Ankle Injuries, treatment and prevention

Twisting an ankle is a very common injury. 25,000 such injuries occur each day in the U.S.A.

The most common sprain is of the outer side of the ankle as it is less stable than the inside.

History of being able to weight bear after an injury with subsequent increase in pain and swelling suggests sprain rather than fracture.

Ligament injuries are graded 1 to 3 according to the extent of damage.

Initial Treatment

a) Treatment with RICE (rest, ice, compression and elevation) for 72 hours.

b) Players should avoid things that would increase swelling eg hot showers, heat rubs, alcohol or excessive weight bearing.

c) Tubi grip bandage will help reduce swelling

d) Antiinflammatories eg. Neurofen will also limit swelling.

e) Taping will give support for weight bearing if possible. The player may be non weight bearing on crutches for 24 hours. Early weight bearing if pain allows will prevent joint stiffness.

f) Early physiotherapy using electrical modalities will reduce pain and swelling. This will in turn reduce muscle wasting.

Further treatment and exercises

a) As soon as possible the player should commence calf stretches in the lunge position.

b) Range of motion exercises i.e. foot up and down, in and out and stationary cycling.

c) Muscle conditioning using theraband should be started as soon as pain allows.

d) Proprioception (joint position sense) is impaired after ankle injury and should be retrained as soon as pain allows. Player stands on affected leg and balances for 1 minute. Progress by repeating but with eyes closed. When this is easy do this on a soft surface eg old pillow or trampoline. Progress further by raising the good leg towards the chest with eyes open and then shut.

e) Functional agility training can commence when the player has minimal pain. This includes side to side shuffling, backward walking, figure of 8 running, jumping and eventually hopping.

Return to Sport.

This can occur when functional exercises produce no pain during or after activity.

Ankle protection should be provided during the rehab. process and upon return to sport. This should be worn for 6 to 12 months following significant ankle injury.

Braces and Tape

Braces have the advantage of ease of application and reduced cost when compared to taping. They do have the risk of slipping and difficulty finding the correct. size.

Neoprene support sleeves offer warmth and comfort but provide little support. Increased support will be gained from straps and laces.

Sports taping provide the most secure support but there can be problems with skin irritation.

Most sprains resolve with treatment but there are some that remain painful 6 weeks after injury and require further investigation with MRI to exclude bony damage.

Jackie Walford May 2005