Ankle Sprains & Running
CAUSES OF SPRAINED ANKLES
In this blog, we wanted to cover ankle sprains in a little more detail as they are something very common in trail running and field sports in the Sutherland Shire. We see these injuries every week at Aevum and the rehabilitation process is a key factor in not only returning to running or sport but also in assisting to limit future injury. For any further information call Aevum Physiotherapy on 85443231.
Under-training
During running, our body adapts to the increased load of the activity by thickening and strengthening tissues to cope with the increased strains. If a tissue such as the lateral ankle ligament is heavily or repeatedly loaded, for example when playing football or netball but has not had enough training to allow it to cope with these loads, the ligament may tear. An example would be the office worker who plays football at the weekend but has not trained during the week.
Over-training
Our body adapts to the increased load of training by thickening and strengthening tissues to cope with the increased strains. If a tissue such as the lateral ankle ligament is heavily or repeatedly loaded without enough time to strengthen, it will break down and may develop tears. Over-training and over-use occur in repetitive sports such a running and over zealous training in any other fast moving or heavy loading sport.
Over-load
When our lateral ankle ligaments are properly trained and conditioned, they are strong and resilient. When there is a sudden strain such as unexpectedly rolling the foot inwards, stressing the ligament with a load greater than it can cope with, it will pull apart creating micro tears which become inflamed as they attempt to repair. Most tears are partial tears, known as sprains but sometimes the ligament will completely tear, known as a rupture. Overload injuries often occur playing tennis, soccer and athletics and are due to:-
Inadequate warm up
Inappropriate training or conditioning
Faulty biomechanics such as weakness, poor muscle flexibility and joint stiffness
Previous and now chronic injury
The Physio will identify and correct any factors which have contributed to the development of the injury.
SYMPTOMS OF SPRAINED ANKLE
There may be stiffness and ache in a gradual onset over-use injury and severe pain with an acute tearing injury. Generally pain and stiffness is mild initially with a slow onset training injury and sudden, strong pain occurs with more widespread tears and inflammation. The more rapid and severe the onset, the greater the damage and inflammation.
DIAGNOSIS OF SPRAINED ANKLE
The diagnosis of a sprained ankle and the choice of treatment will need to be made by a qualified Physiotherapist. A thorough examination is sufficient to diagnose the type and degree of ligament tear. Ankle ligament tears may be complicated by cartilage damage, subchondral bone fractures and subtalar capsulitis with other investigations such as an ultrasound scan, arranged if extra information is required.
TREATMENT OF SPRAINED ANKLE
Sprained ankles heal best when treatment has begun as soon as practical following injury. The sports person must immediately stop the sport and avoid any movement which produces the pain. In the case of sudden onset pain cryotherapy the RICE protocol should commence. This is:-
Rest: Rest from aggravating movements to reduce further bleeding and injury.
Ice: Ice wrapped in a wet towel and applied to the injury for thirty minutes every two hours.
Compression: The ankle may be bandaged to reduce swelling but not during sleep.
Elevation: The leg may be elevated to a 45 degree angle to drain swelling.
Medications
Pain killers may be needed initially and anti-inflammatories may be used after 48 hours when bleeding has stopped. Often people shy away from these as an option choosing to instead deal with the pain. While this is recommended in many instances with an ankle sprain, if suggested by your Physio, this will help with early mobilisation/walking and rapidly improve recovery.
Advice regarding
The injury diagnosis
Anti-inflammatories and pain killers
Compression and ICE
Taping to unload the injured ligament
Degree of loading required when walking or returning to running
Direct Physiotherapy Treatment
Recovery room (cold therapy and compression)
Stretches
Tape
Soft tissue treatment
Joint mobilisation
Exercises to regain strength, movement and proprioception
Graded return to running or sport program
Physiotherapy Management of return to sport
Technique modification / running analysis
Provision of orthotics and footwear advice
Providing a return to sport plan
Management may require the use of crutches or a walking stick to reduce the load on the ligament. As the injury begins healing, our Physio will advise a graduated return to exercise without an increase in symptoms. Depending on which tissues are injured there will be stretches, strengthening and mobility exercises to return full function and coordination, to reduce the chance of the injury recurring.
In the event of a severe injury where Physiotherapy is not appropriate, the patient will be referred directly to a doctor or appropriate professional for further investigation and treatment. In the event surgery is required, Physio rehabilitation will be arranged afterward.
PROGNOSIS OF A SPRAINED ANKLE
Sprained ankles recover well with early Physio management. Full injury recovery may take between one and six weeks depending on the extent of the injury. The goals of treatment are to achieve the best quality of healing with a pain free full range of movement and normal function, so there is a minimal likelihood of a recurrence in the future. For more information about sprained ankles contact Aevum Physiotherapy in the Sutherland Shire on 85443231.