Ankle Sprain: Common And Chronic

Ankle Sprain Injuries Are Often Frustratingly Chronic

Statistically a high percentage people who roll their ankle will still experience issues with their ankle up to two years following the original sprain. These are pretty alarming stats and for me highlights the need for receiving professional advice for any ankle sprain regardless of the perceived severity. Seeing a physiotherapist can help to avoid persistent issues, or a recurrence of sprains. Receiving assessment and management advice early on from a physiotherapist can help with both an accelerated return to full activity levels and assist in the prevention of any ongoing complaints like pain, stiffness or instability.

An Inability To Bear Weight Following An Ankle Sprain Indicates Increased Severity Of Injury

With regard to knee injuries an audible sound of a “pop” or “crack” associated with a rotational injury in the athletic knee, will more often than not indicate an ACL rupture and there is a rule that it is a ACL rupture till proven otherwise. With the ankle there is no such link and the correlation between twisting your ankle and hearing a pop (or another audible noise) and severity of injury doesn’t necessarily exist. So, twisting your ankle and hearing a crack at the time of injury doesn’t always indicate that there has been a fracture or ligament rupture. However conversely, the absence of any pop or crack doesn’t also mean you haven’t done something more serious… There is however a strong correlation between an inability to bear weight immediately following injury and the severity of injury so if you “sprain” your ankle and can not put any load on your ankle they suspicion is injury severity is high and absolutely warrants professional assessment and potential investigations.

“Minor” Twisted Ankles Can Often End Up Taking A Long Time To Bounce Back To Normal

In my Sydney physio practice I commonly see patients having had singular (or multiple episodes) of what they perceive as “minor” sprains having written them off as insignificant. Frustratingly for these patients they are commonly the individuals who go on to experience symptoms well beyond the time frames that would normally be expected and end up seeking professional assistance further down the track. I feel a potential reason for this is that patients suffering more painful and therefore perceived more “severe” sprains will generally seek help early on. And in doing so they will be assessed, diagnosed and given appropriate advice to assist in the management of their injury. Considering they originally perceive their injury as more serious I often find they are also more likely to adhere to their rehabilitation guidelines and generally do really well as a result of this approach. On the flip side patients not seeking assessment and management advice early on, or, those who originally discern their injury “insignificant” because initially their pain levels fairly rapidly reduce and function quickly returns, will often forgo undertaking any rehabilitation program, or if they do partake in some rehabilitation the regularly give it away shortly after starting. These are often the patients left ruing their decision to do so, as they end up experiencing ongoing pain, stiffness, instability and/or repeat episodes.

The take home here is that regardless what you may believe with regard to the severity of any ankle sprain, or injury suffered, it is always a good idea to have your ankle assessed sooner rather than later by your physiotherapist, or otherwise appropriately skilled practitioner.

Don’t Stop Your Rehab Exercises Because You Think You’re “Better”

With regard to ankle sprain management it has been shown that supervised rehabilitation exercise programs reduce re-injury rates by 50%. So, what’s the catch..? Well the kicker is that the rehabilitation program needs to be carried out for at least 6-10 weeks. Now, obviously most people following a mild – moderate ankle sprain will return to sport prior to this 6-10 week post-injury marker. With many athletes often capable of returning to play with-in only a few weeks following injury and typically once people return to play they also stop doing their rehab exercises. This is logical as once people return to pre-injury activity levels they have the misguided belief that if they are back playing, they must be fine. What this research suggests is that if you wish to reduce likelihood of repeat ankle sprain episodes, or any associated on-going problems you are best to continue your program that few weeks longer, meaning just because you are back in the team you need to keep doing your individual work that little bit longer.

RICE: An Oldie But A Goodie With An Ankle Sprain

Physiotherapists as a group of professionals are well placed to advise on the management of ankle injuries be they acute or chronic. The sooner you visit your physiotherapist the better and as with the majority of acute joint injuries early ankle sprain injury management may benefit from the use of R.I.C.E. As a first aid treatment approach R.I.C.E. is generally best applied A.S.A.P. following the trauma. Physiotherapists typically endorse adding a couple of extra letters to the acronym with it becoming P.R.I.C.E.R. which stands for:

• Protection
• Rest
• Ice
• Compression
• Elevation
• Referral

Worth noting is that the “Rest” part of the acronym is ideally what is referred to as active rest and involves some controlled protected movement and/or loading as appropriate. The goal is to create the right environment for your bodies biology to start the healing process something that is crucial to obtain the best short and long term outcome. The modified R.I.C.E. acronym being expanded into P.R.I.C.E.R. where “P” for Protection of further injury by properly supporting the injury and “R” for Referral on-wards. Referral for appropriate imaging or orthopaedic assessment can ultimately assist by enhancing the understanding with regard to the need for, type of, and duration of “Protection” that is required. Generally my preference is people employ R.I.C.E. immediately after ankle ligament injury whenever possible and this frequently can persist all the way through till around the 7-10 day mark, but this depends heavily on individual circumstances.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding a “Ankle Sprain” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.