The most common ankle sprain is called an inversion sprain. This normally occurs when your foot rolls in causing pain on the outside of your ankle. There are three ligaments on the outside of your ankle that can be involved: the anterior talofibular ligament, calcaneofibular ligament, and the posterior talofibular ligament. The majority of inversion ankle sprains involve the anterior talofibular ligament. The calcaneofibular and posterior talofibular ligaments can also be involved, but are less frequently injured. The severity of ankle sprains can vary from a mild stretching of the ligaments to a full rupture.
The biggest initial concern with an ankle sprain is the risk of a fracture. To determine if X-rays are necessary, we utilize what are called the Ottawa Ankle Rules.
Ottawa Ankle Rules:
- Tenderness on the lateral or medial malleolus
- Tenderness on the base of the fifth metatarsal or navicular
- Inability to bear weight immediately or at time of examination
If any of these findings are positive, it is recommended to have an ankle/foot X-ray taken to determine if a fracture is present. While negative findings don’t completely rule out a fracture, the Ottawa rules have a very high rate of ruling out fractures.
Once we are confident there is not a fracture, we can begin treatment. A common treatment method for treating ankle sprains is the RICE protocol, which stands for rest, ice, compression, and elevation. While the RICE protocol has become a main-stay for ankle sprains, it’s effectiveness has recently been called into question. A review in the Journal of Athletic Training found limited evidence to support the use of rest, ice, and compression for ankle sprains in adults. Many other articles have looked at the effectiveness of ice, specifically, and have found either insufficient evidence or a lack of effectiveness for the treatment of soft tissue injuries.
An emerging protocol for ankle sprains is the MEAT method: Mobilization, Exercise, Analgesics, and Treatment.
As opposed to the RICE protocol, early mobilization is encouraged. Mobilization of the ankle promotes a quicker return to play and also helps to reduce swelling. Depending on the severity of the ankle sprain, a brief period of rest may be necessary. Drawing the ABC's with your foot would be an example of an early mobilization drill.
Once tolerable, beginning to exercise on the ankle can increase blood circulation to the area (which is needed for healing) and also strength the ligaments and muscles. While the traditional band strengthening exercises have their place, balance/proprioception training and functional training should be the emphasis. Wobble boards and balance beam training are some of the exercises that could be used to improve balance and proprioception.
While analgesics won’t do anything for healing the tissues or preventing another ankle sprain, they will decrease the pain which will make the short-term more tolerable. It is important to note that NSAIDS such as aspirin and ibuprofen have been shown to reduce tendon and ligament healing. Short term use of acetaminophen (Tylenol) may be a better choice as an analgesic.
There are plenty of options for the treatment of ankle sprains. Manual and instrument-assisted soft tissue therapies are a great place to start. These therapies can help reduce the amount of swelling and restore the proper biomechanics in the ankle. The addition of RockTape to an ankle sprain will also decrease the amount of swelling. Joint manipulation to the ankle can also facilitate proper biomechanics and improve proprioception.
While ankle sprains are a common injury, proper care is important to prevent long term problems. The first step in evaluating an ankle sprain is to rule out a fracture. Once the risk of a fracture has been ruled out, treatment can begin. Although the RICE protocol is a popular treatment method, it may not be as effective as previously thought. The MEAT method provides both short term pain relief as well as long term prevention from recurrent ankle sprains. If you have suffered from an ankle sprain, have your ankle evaluated by the team at Velocity Sports Rehab.