It was just a normal afternoon in the gym during a pickup game. The score was tied, game point. Nate goes up for the dunk and it goes in! When he comes back down to land, something didn’t feel right. His ankle was hurting really bad and was starting to swell. He couldn’t even walk on it. Nate sprained his ankle. Most ankle sprains happen when you make a rapid shifting movement with your foot planted, such as when you play soccer or get tackled in football. Often the ankle rolls outward and the foot turns inward.
This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle. An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful.
In a severe ankle sprain, the ankle is unstable and may feel “wobbly. ” You can’t walk, because the ankle gives out and may be very painful. With most sprains, you feel pain right away at the site of the tear. Often the ankle starts to swell immediately and may bruise. The ankle area is usually tender to touch, and it hurts to move it. In more severe sprains, you may hear and/or feel something tear, along with a pop or snap. You will probably have extreme pain at first and will not be able to walk or even put weight on your foot.
Usually, the more pain and swelling you have, the more severe your ankle sprain is and the longer it will take to heal. Preventing this injury is not that hard. According to emedicinehealth. com wearing the proper shoes, keeping the ankles strong and flexible, consider wearing ankle tape or an ankle brace, and making sure playing field or home environment is clear of any obstacles that could lead to injury. Healthscout. com says to maintain a regular exercise program, wearing stable shoes, stretching calf muscles before and after exercise, and maintain a healthy diet to prevent injury.
But sometimes all these measures do not work and you will have an ankle injury and there are risks of reinjuring. How can we minimize recurring injuries? Brandon Hemphill, James D. Whitworth, and Rita F. Smith say that using external support during physical activity significantly reduces the likelihood of spraining your ankle. A study done by University of Georgia suggests that the different ways people move their hip and knee joints may influence the risk of re-injury.
“If you have ankle sprains, you may have a problem with the way you move, and we think we can change movement through rehabilitation,” said Cathleen Brown, lead author of the study and assistant professor in the department of kinesiology in the College of Education. Past studies on ankle sprains have shown that some people are able to return to sports or physical activities without a problem. Brown and her team, which includes associate professor Kathy J. Simpson, also in the kinesiology department, want to know why some recover completely.
“One theory for explaining those divergent paths is that a person comes up with good strategies to move, land, balance and not get re-injured,” Brown said. “Maybe the injured people don’t use the same landing strategies, or their strategies aren’t as effective,” Brown said, adding that the study was a snapshot in time, not a long-term follow-up. By the time subjects were included in the research study, they have usually already injured themselves. “We don’t know if they are this way because of the injury, or if they got this injury because they land this way. ” There are two different initial treatments for an ankle sprain.
One is RICE, consisting of rest, ice, compression, and elevation. The other is PRINCE, consisting of protection, rest, ice, NSAIDs; or non-steroidal anti-inflammatory drugs, compression, and elevation. The physician may suggest to keep all or some of your weight off your ankle and will give you crutches or a walker. An ankle brace, air stirrup, hiking boots, or other form of ankle support should be worn during this time to protect the ligaments. Stretching exercises should be continued daily and especially before and after physical activities to prevent re-injury.
Even after your ankle feels better, continue with muscle-strengthening exercises and balance and control exercises several times a week to keep your ankles strong. The timing and type of rehab exercises may vary according to your doctor’s or physical therapist’s preferences. Anti-inflammatory pain medications such as ibuprofen and naproxen are used to reduce the pain and combat swelling. Ankle sprains are commonly misdiagnosed. This is because the two major types of sprained ankles-high ankle sprains and lateral ankle sprains-often look the same, even though they affect entirely different ligaments.
The less common type, a high ankle sprain, is often mistaken for a lateral sprain. Misdiagnosis can delay getting the right treatment-and that can impair recovery. “One problem is that the symptoms of high ankle sprains parallel those of the lateral ankle sprain, which occurs in the lower ankle area,” says Marque Allen, DPM, FACFAS, foot and ankle surgeon from San Antonio, Texas and a Fellow of the American College of Foot and Ankle Surgeons. Pain, swelling, limited motion, and bruising in the entire ankle region can occur in both high ankle sprains and lateral ankle sprains.
The difference lies in where the injury occurs and which ligaments are involved. “High ankle sprains can get complicated, because this region has five ligaments connecting two bones in the leg, compared with three ligaments that can be affected in lateral ankle sprains,” says Dr. Allen. In diagnosing an ankle sprain, it’s important for physicians to understand how the injury occurred. Lateral sprains are caused by the foot turning inward, whereas high ankle sprains are the result of the foot being forced outward.
Other complications include ankle synovitis, which is inflammation of the inner lining of the ankle joint capsule, persistent swelling of the ankle, lateral ankle instability, and nerve injuries. There are many different exercises one can do during the rehabilitation period. For example, range of motion exercises, strength exercises, and activity-specific exercises. Proprioception exercises and other balance exercises can help you recover more quickly and should actually be performed as part of a prevention program. Poor balance is a good predictor of future ankle sprains.
After an ankle injury, balance training is essential to recovery. In addition to our eyes and inner ears, there are special receptors in our joints, proprioceptors, which provide information about our position in space. By balancing on one leg, you can reinforce and strengthen those receptors in the ankle. Balance on the affected leg and hold steady for 15 seconds. Continue to challenge your ankle by balancing with your eyes closed, or with your head turning from side to side. If you play soccer, balance on your sprained ankle and kick a soccer ball against a wall.
If you play basketball, balance and shoot or practice bounce passes. You can get creative with your exercise to match your sport. The Ottawa ankle rules are a set of guidelines for clinicians to aid them in deciding if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Before the introduction of the rules most patients with ankle injuries would have been X-rayed. However only about 15% of X-rays were positive for fracture, other patients had sprains or other injuries.
As a result many unnecessary X-rays were taken, which was costly, time consuming and a possible health risk. The rules state that X-rays are only required if there is any pain in the malleolar zone and any one of the following: * Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR * Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR * An inability to bear weight both immediately and in the emergency department for four steps.
The Ottawa foot rules are for assessing whether a foot X-ray series is indicated. It states that they are indicated if there is any pain in the midfoot zone and any one of the following: * Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR * Bone tenderness at the navicular bone (for foot injuries), OR * An inability to bear weight both immediately and in the emergency department for four steps. It is best to refrain from returning to full activity before complete healing of the ankle has occurred in order to avoid re-injury and possible complications.
Ankle sprains take an average of 6 weeks to heal but can take can up to 4 months, depending on the severity. After returning to your sport, you have to make sure you take all precautions. Especially by making sure your ankle is supported by a brace or by tape. Some studies have shown that braces are more effective than tape, though. Either one is better than no support. In conclusion, preventing yourself from injury is a lot easier than people think. But if injury does occur, don’t assume you will be out for 4 months. People heal differently and how long healing takes depends on the severity of the injury.
Works Cited “American College of Foot and Ankle Surgeons: Sprained Ankles Can Be Complicated – and Misdiagnosed. ” India Pharma News (2012). Http://galenet. galegroup. com. ezproxy. aacc. edu. 2 Mar. 2012. Web. 28 Mar. 2012. Hemphill, Brandon, James Whitworth, and Rita Smith. “Q / How Can We Minimize Recurrent Ankle Sprains? ” Journal of Family Practice 60. 12 (2011): 759. Http://galenet. galegroup. com. ezproxy. aacc. edu. Web. 28 Mar. 2012. “UGA Study Suggests Key to Avoiding Ankle Re-injury May Be in the Hips and Knees. ” NewsRx Health & Science (2011): 321. Http://galenet.
galegroup. com. ezproxy. aacc. edu. Web. 28 Mar. 2012. “Ankle Sprain Causes, Symptoms, Treatments, Recovery. ” WebMD. WebMD, 19 May 2011. Web. 28 Mar. 2012. <http://www. webmd. com/a-to-z-guides/ankle-sprain-overview>. “Health Encyclopedia – Diseases and Conditions. ” Ankle Sprains. The HealthScout Network, Inc, 1 Apr. 2009. Web. 28 Mar. 2012. <http://www. healthscout. com/ency/1/572/main. html>. Cunha, John P. “Read What Your Physician Is Reading on Medscape. ” EMedicineHealth. Web. 28 Mar. 2012. <http://www. emedicinehealth. com/ankle_sprain/article_em. htm>.