Presented by: Pamela Anthony, PT, MPT, ATC, Owner, AccuCare

However, in the case of a major misstep or athletic injury, one may experience swelling, bruising, and severe pain. As the old adage goes, treatment involves:

• Rest
• Ice
• Compression and
• Elevation.

But is that really all there is to this all too common injury? Or are there further steps we can take to treat and prevent recurrent ankle sprains?

? What is a sprain, anyway?

A. A sprain is a type of injury to a ligament. There are three major types of ligaments; however, in relation to joint structure, a ligament is a type of connective tissue that connects bone to bone. The function of ligaments is to improve the stability of a joint to varying degrees. Sprains refer to stretched or torn ligaments and typically occur in the ankle during a fall, missing a step on a flight of stairs or stepping into a ditch, or landing awkwardly when jumping, running, or cutting. Because ligaments are elastic, they are able to stretch and will remain stretched. This is why sprained ankles need to be treated properly; the ligaments stretch past their normal limits during the sprain and can remain lengthened. This, in part, increases the likelihood of a “repeat offense”, so to speak. Instead of limiting the joint to a specific range of motion when stressed, the newly sprained (stretched) ligaments will allow the joint to move further than it normally would, thereby respraining the ligaments.

There are three major types of ankle sprains: Inversion ankle sprains, eversion ankle sprains, and high ankle sprains. Inversion sprains typically occur when the foot forcefully turns inward and pain is noted primarily at the outside (lateral) portion of the ankle.

In an inversion ankle sprain (which is most common), three major ligaments can be damaged and the degree of the damage determines the grade of the ankle sprain (see figure 2). In a Grade 1 ankle sprain, the anterior talo-fibular ligament (ATFL) is damaged. In a Grade 2 ankle sprain, the ATFL and the calcaneofibular ligament (CFL) are damaged. In a Grade 3 ankle sprain, the ATFL, the CFL, and the posterior talo-fibular ligament (PTFL) are damaged. Grade 1 ankle sprains typically are the least severe, while Grade 3 ankle sprains are the most severe, because damage is done to three ligaments as opposed to one.

? What are the symptoms of a sprained ankle?

A. The symptoms of a sprained ankle include swelling, bruising, pain, and tenderness to touch. Depending on the severity of the sprain, the ankle may be anywhere from minimally swollen, bruised, and tender, to severely swollen, bruised, and tender.

? How are ankle sprains diagnosed?

A. Ankle sprains can be diagnosed by a physical exam performed by a physician; however, x rays or MRIs can give the physician a better idea of the extent of the injury and if there are any fractures in the bones of the lower leg or foot.

? I sprained my ankle . . . what do I do now?

A. If you saw a physician or went to the ER, you probably were provided with instructions to follow. The physician may have written a prescription for physical therapy which will decrease swelling, improve ROM, strength, and return you to prior level of activity. However, if you did not see a physician, it is always safe to follow the acronym PRICE – Protection, Rest, Ice, Compression, Elevation. Protect your ankle by using an ankle brace, air cast, or crutches. Rest your ankle and avoid putting weight on it if it is painful (especially for the first 24-48 hours) – again, use crutches if necessary. Ice will help to reduce pain and swelling – 20 minutes on, and about 20-30 minutes off every 3-4 hours. Avoid putting ice directly onto your skin to avoid frostbite – wrap the ice/bag of frozen veggies in a towel first. Compression can be provided by a snugly wrapped ace bandage – but be sure that you do not wrap it so tightly than you notice tingling or loss of sensation in your toes. Finally, Elevation will help to decrease pain and swelling, but make sure that you elevate the ankle so that it is above the level of your heart – if it is not above the level of your heart, the reduction in swelling can be minimal.