An ankle sprain is arguably the most common sports related injury experienced (of any sport and at any age). Sprained ankles have been estimated to make up about 30% of sports injuries (many are not reported so this may be significantly higher).

Causes

• Most commonly the outside of the ankle is sprained from the foot rolling inwards (Inversion Sprain) but is can occur on either side.
  
• Contact injury (e.g a direct force)
• Non-Contact Injury (e.g. sudden overstretching, twisting, awkward planting, cutting/pivot of the foot)
• Sudden twisting on an uneven surface
  
• Overuse (e.g. repetitive strain)
• Previously untreated ankle sprain

Grading of the Sprain
Sprains are graded depending on severity:

• Grade 1: The most common injury. Ligaments are overstretched. Few torn fibers with the structure of the ankle working and moving relatively well. Mild/no swelling. No or little limping.
  
• Grade 2: A little more severe. Incomplete tear with some ligament instability. There is still some stability with putting weight through the ankle. Some swelling. Some limping with walking.
  
• Grade 3: Severe Sprain. Complete tear of the ligament and severe instability. A lot of swelling. Unable to put weight on the foot.
  

Signs and Symptoms

• Pain will generally relative to the severity (or grading) of the injury.
• Pain commonly comes on immediately.
  
• A distinct point of tenderness over the ligament with/without bruising and/or swelling over the area.
• You may not be able to put weight through that ankle.
  

Osteopathic Treatment

• Your osteopath will perform a detailed past medical history and physical examination to determine the extent of the damage in your ankle and grade the knee injury.
• Initial treatment will focus on reducing pain and enhancing drainage and blood flow to the damaged tissues.
• Your osteopath may refer you for imaging studies (MRI/CT or ultrasound) to for clarification on the tissue damage or to rule out other causes of the pain.

Self Management

• Ice is beneficial in the first 24-48 hours (3 sets of 10 minutes on 10 minutes off - 3-4 times per day).
• Elevate the ankle and wrap a compression bandage to allow drainage of the foot.
• Crutches may be beneficial over a short course (as determined by your osteopath).
  
• A short course pain relieving and/or anti-inflammatory medication may be of benefit with consultation of your doctor or pharmacist.
• Ankle sprains can recur if they are not managed properly. Once pain has settled you will be prescribed stretching and strengthening exercises with an aim to restoring your ankle to its pre-injury state and make it stronger with an aim to prevent recurrence.
• You will also be educated on lifestyle and ergonomical factors that may have contributed to the sprain.
• Click here for the Ankle Rehabilitation Program
• Click Here for Ankle, Leg and Foot Stretches
• Click Here for Ankle, Leg and Foot Strengthening

Healing times
Healing of collagen of a partial ligament tear can take several months1,2. Recent evidence on acute ankle sprains suggested anywhere between 6 weeks to 3 months before ligament healing occurred3. Returning to normal activities is determined by the severity of the sprain/tear and may take place before complete healing in some cases if the ankle has appropriate stability.

References

• 1. Frank C. Ligament Healing: Current Knowledge and Clinical applications. J Am Acad Orthop Surg 1996;4:74-83
• 2. Frank C, Shrive N, Hiraoka H et al. Optimisation of the biology of soft tissue repair. J Sci Med Sport 1999;2(3):190-210
• 3. Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence based approach. J Athl Train 2008;43(5):523-9