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What does it mean to sprain your ankle?

What does it mean to sprain your ankle?

This is probably one of the most common injuries incurred in sport. Inversion ankle sprains (the most common type) make up 25% of injuries affecting bones and muscles. Primary care physicians see about 1 million ankle sprains annually. So this injury happens a lot and most people tend to manage this injury themselves with some ice, some rest and maybe a compression wrap. Then they wait. They just wait out the pain and swelling before heading back because it's 'just an ankle sprain.' But properly managing a sprained ankle matters and it affects the future health of your ankle. How many times have you heard - 'I just have bad ankles.' No one has inherently 'bad ankles.' More accurately, ankles become more and more prone to injury with each injury incurred. In this post we're going in-depth with the ankle sprain injury.

To understand the ankle sprain, it helps to review some basic anatomy. The ankle is the meeting point of a number of structures. Namely the lower leg bones (tibia and fibula), the heel bone (calcaneus) and the foot bones. There is also one more really important bone that sits in the middle of all this called the talus. It's highlighted in green. The bones are held together by ligaments - which attach bone to bone.

Spraining your ankle means that the ligaments that hold your ankle together have been stretched beyond their capacity. The sprain creates microtears in the ligament and if it's bad enough it could result in a total rupture of the ligament. Here's what that continuum looks like. At the extreme end of this spectrum is the risk of bone fracture - so keep that in mind too. There are some basic tests a medical professional can do right on field to determine if a fracture is likely

Generally 'ankle sprain' can be a bit of a catch-all phrase because there are many ligaments that hold these bones together and a number of them are commonly sprained. Depending on the ligament injured and the degree of injury each 'ankle sprain' can look very different. Here you'll notice that the location of swelling and bruising is very different in each case.



The differences across ankle sprains matters because each type of situation will require a different strategy to get you better. Locating the exact ligaments, muscles and joints that were affected is important.

Your physical therapist, athletic trainer or doctor can examine your injury to determine what ligament was damaged. They make their diagnosis based on a number of things such as the pattern of bruising and swelling, by conducting physical tests, by checking where pressure is painful, etc. The way you sprained your ankle can also help determine which ligament was sprained. For example, did you hurt your ankle when falling down from a jump or while attempting a quick cut on the soccer field? All these different types of sprains can be grouped in to 4 categories:

Inversion sprain: This is easily the most common type of ankle sprain. It affects the three ligaments on the outside of the ankle and occurs if you roll too far over the outside border of the foot. Medial eversion sprain: This is the least common type of sprain and takes a lot of force because there is a boney ridge that actually protects the ankle against it. It occurs if you roll too far over the inside border of the foot while the foot is pointed upwards.


High ankle sprain: This affects the ligament that helps hold together the lower leg bones. It can occur when you land from a height and the ankle is forced into rotation. It's less common than the inversion sprain, but it can be more debilitating.

Low ankle sprain: This affects a ligament that supports bones of the foot that sit very close to the ankle. It can occur when your foot rolls over your toes, often when landing from a height.

Muscles strains: This is more of a concomitant problem than a type of ankle sprain exactly. But it's important to consider that it's not just the ligaments that get injured, the ankle muscles can take a beating too.

So here's the biggest problem with this type of injury: the more often you sprain your ankle, the more prone you are to future sprains! And often the next one is worse because you're working with sub-optimal control in the area. If not treated properly, ankle sprain injuries can result in persistent problems in 30-40% of people. This happens for a number of reasons.
  1. Ligaments are like gum. Once you stretch them out, they don't contract back to their original length.
  2. Less ankle movement. Remember the talus? It can shift forward ever so slightly, and that can result in ankle pain because the ankle bones aren't sliding and gliding as well
  3. Less optimal joint and position sense due to a jumbled message from the position sensors in the ankle muscles.
To most people spraining the ankle sounds like a pretty innocuous event, but it can result in debilitating injury. It's complicated too, because the ankle can be sprained in a number of locations and directions. The last thing you want to do is just ice and wait. Now that we know how the ankle can be injured, next post we'll focus on what you should do about it.

References:


What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? journal of athletic training

Bleakley, C. M. et al. Effect of accelerated rehabilitation on function after ankle sprain: Randomised controlled trial. BMJ 340, c1964-c1964, 10.1136/bmj.c1964 (2010)

Bleakley, C. M., Glasgow, P. & MacAuley, D. C. PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine 46, 220-221, 10.1136/bjsports-2011-090297 (2011)

Bleakley, C. Supervised physiotherapy for mild or moderate ankle sprain. BMJ i5984, 10.1136/bmj.i5984 (2016)

http://physioworks.com.au/injuries-conditions-1/high-ankle-sprain

Kerkhoffs, G. M. et al. Diagnosis, treatment and prevention of ankle sprains: An evidence-based clinical guideline. British Journal of Sports Medicine 46, 854-860, 10.1136/bjsports-2011-090490 (2012)

Van der Wees, P. J. et al. Effectiveness of exercise therapy and manual mobilisation in acute ankle sprain and functional instability: A systematic review. Australian Journal of Physiotherapy 52, 27-37, 10.1016/s0004-9514(06)70059-9 (2006)

Hupperets, M. D. W., Verhagen, E. A. L. M. & Mechelen, W. v. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: Randomised controlled trial. BMJ 339, b2684-b2684, 10.1136/bmj.b2684 (2009)

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