By Sue Reive
September means back to school and the start of many sports like football, running and soccer. Unfortunately, some people will suffer a sports injury. Ankle sprains are one of the most common injuries; they comprise 14 per cent of all sports-related injuries and 50 per cent of soccer injuries. Early treatment ensures a better outcome. Indeed, physiotherapy helps guide the healing process to facilitate a better recovery and prevent re-injury.
The most common mechanism of injury is rolling over on the outside of the ankle which sprains the lateral ligament complex. Athletes will often sprain the ligament when landing from a jump, especially when landing on another players’ foot.
There are three grades of ligament sprain. Patients with a grade one sprain have micro-tearing of the lateral ligament and will usually be able to weight bear after the injury. Grade two ligament sprains are accompanied by more swelling and visible bruising as the ligament fibers are more torn and there is definite instability. Weight bearing is painful, and patients will usually hop off the field or court. They may require crutches for a few days. Grade three tears are significant with marked instability. The patient cannot weight bear and requires crutches. Initially, ankle mobility is greatly reduced due to pain. An X-ray should be taken if there is marked pain and the patient cannot walk four steps immediately following the injury. With some ankle sprains, the torn ligament can pull a small chip of bone off its attachment; this is known as an avulsion fracture and will usually appear on an X-ray.
Treatment varies depending on the grade of sprain and the stage of healing. In the acute inflammatory phase, the RICE method (rest, ice, compression and elevation) is employed. Taping and bracing are important to provide stability and prevent re-injury. Grade three sprains and severe grade two sprains require an air cast to immobilize and allow healing of the torn ligament. Moreover, crutches are used for protective weight bearing. People often ask if they should be walking on a sprained ankle. I advise people to listen to their body; if it hurts to fully weight bear then use crutches or a cane to reduce the load on the injured ankle. Specific active movement starts in the first week and progresses to resisted strengthening exercises. Weight bearing progresses as able. Eventually, balance drills, hopping and running are given, usually around the fourth week for grade two sprains. Return to sport should be gradual and use of a brace is recommended.
Grade one ankle sprains resolve fairly quickly, usually in one to three weeks. Grade two sprains take four to six weeks and grade three sprains require a few months. The body has stages of healing which dictate our recovery. Scar tissue only starts to be laid down in the second week after an injury and is not strong until four to six weeks post injury.
The goal of physiotherapy is to produce strong yet extensible scar tissue, regain normal strength and balance and ultimately allow a resumption of sporting activities without pain or dysfunction.
Susan Reive is a physiotherapist at the Ottawa Physiotherapy and Sports Clinic in the Glebe.
Illus at https://complete-physio.co.uk/