Ankle sprain

 

Ankle sprains are one of the most frequently seen lower limb sports injuries and are the most common musculoskeletal injury with which people attend Accident and Emergency departments. Ankle injuries have far reaching consequences but are all too often dismissed as just an ankle sprain and considered of low significance. This may indicate why this injury is so prevalent and so often a repeat offender, recycling itself for another day. The analogy of an iceberg may well illustrate the recovery from such a sprain. Once the pain resolves (tip of iceberg), function returns but, all too often functional deficits remain and while not apparent, are likely to contribute to injury recurrence.

 

Mechanically, the ankle joint plays a key role acting as part of the interface where body meets ground. The ankle is required to rapidly adapt to uneven surfaces and transfer large forces to the ground while the body weight moves over it and propels itself forwards. The ankle has to do all of this and most of all stay intact itself as it serves this difficult and complex function, and sometimes the demands are too great.

 

Injury can easily occur during daily activities such as stepping of a curb or can be from participating in sports involving running (particularly on uneven surfaces), jumping and changing direction (Basketball / Netball comprise all of the above). People often describe their injury as having “Rolled” their ankle. That is they have taken weight through the outside of their ankle with resulting pain inability to stand on their leg due to pain.

 

This injury can vary greatly in severity depending on the speed, direction and overall mechanism of injury.  Symptoms reported can range from minimal pain and limited function to severe where the individual is unable to walk independently on the ankle for several weeks. Structures injured in a mild ankle sprain would include mild damage to ligaments and muscles surrounding the ankle joint. However, a severe sprain has been shown to  cause significant damage to several ligaments, muscles, profuse swelling (limiting ankle movement) and changes in spinal reflexes have also been demonstrated.

 

The inability to take weight through the ankle after the original injury is always a concern as it may / (or may not) be suggestive of an underlying fracture. Review with medical practitioners at A&E or your GP surgery can advise you regarding appropriate action. Early conservative management (see PRICE guidelines) and early mobilisation (ankle movement) has consistently demonstrated better outcomes for this injury compared to no activity or immobilisation.

 

However, one key characteristic of the ankle sprain is that it being a ‘repeat offender’; people report as having repeatedly episodes with resulting long term consequences which can build up with time. Such changes can result in several different clinical presentations with differences in joint and muscle function. Specific assessments can identity joint structures and muscles involved, enabling an appropriate treatment plan to target structures involved.

 

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