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Injury: Ankle Sprains.

By 24 September 2020Injury Rehab, Latest

We asked Claire, one of our PTs and sports massage therapists what is the best way to deal with a sprained ankle. This is what she said.

“I have so much fascination and respect for the human body. Its innate intelligence, the complexity of all its systems that function continuously without any conscious input, the ways in which we are all so unique and yet share so many commonalities.

As such, nothing breaks my heart more than seeing an injury or pain not be given the full amount of attention or compassion it deserves.

The most classic example? You roll your ankle – it’s sore, swollen, red, angry – you go to A&E where they agree it looks pretty bad, and send you for an X-ray – the X-ray comes back and fails to show a fracture – “It’s OK, it’s just a sprain, go home and rest it” you are told. So you do, relieved that you haven’t broken anything. And yet, two weeks later… four weeks later… six weeks later… Your ankle is still sore. So you keep holding back on your activities, maybe you drive more than walk, possibly get a little frustrated at your ankle for not healing or at yourself for worrying about it.

I am not sure when we got to the point where a fracture became the only valid injury to receive treatment for. A stress fracture or hairline fracture gets more attention than a grade 2 sprain, despite the latter actually entailing more tissue damage (and a potentially more complex recovery process).

Let’s start by explaining what a sprain actually is:

A sprain is a tearing of ligament fibers.
A strain is a tearing of muscle or tendon fibers (also referred to as a “pulled muscle”).
A fracture is a break of the tissues that make up a bone.

They are all the same type of injury – a disruption in the cells that make up a tissue – but affecting different bodily tissues. Sprains, strains, and fractures all exist on a continuum from, essentially, “a few fibers in the structure being damaged” to “partial tear of the structure” to “total rupture of the structure” (then fractures are further classified according to the shape and placement of the break, for example, whether the bones have shattered or whether a bone has pierced the skin).

Admittedly if you have a grade 1 ankle sprain, you may just have a few overstretched ligament fibers, that will heal on their own with rest. But if you have a grade 2 ankle sprain, it could be that half of the ligament is torn, and although it might heal on its own, the scarring will be significant enough that you will feel stiffness in the ankle for a long time if not appropriately treated or rehabilitated. And if it’s a grade 3 sprain, the entire ligament may have ruptured, in which case it may require surgery.

The difficulty with sprains, besides the fact that few people take them seriously, is that ligaments are pliable soft tissues so realigning the “broken ends” is not as simple as keeping a fractured bone in alignment. In addition to this, ligaments suffer from poor blood flow, so struggle to receive the nutrients they need to rebuild.

 

Stages of a soft tissue’s healing process

I often encourage people to think about the healing process a soft tissue injury goes through, inside our bodies and invisible to us, through the lens of a visible injury to the skin.

First, it bleeds and your priority is to stop the bleeding (and keep it clean). Then you need to leave it alone, so a scab has a chance to form – if you keep poking it and moving the skin around, you’ll keep breaking that delicate new scab. Once the scab has fully formed and dried out, it might start to feel stiff, so in order to avoid it getting pulled off before the wound underneath has healed, it’s a good idea to start moisturising it, using very gentle movements to work some oil into the scab to keep it pliable but without irritating it. Finally, the scab comes off, and your skin feels normal, though the new skin may look and feel a little different for a while.
The healing process for a soft tissue injury is similar, as is how you should deal with it to help it
along:

  1. First, it bleeds, causing swelling and redness and inflammation – your job is to let those processes happen without letting them cause further issues – rest, keep the limb elevated, use ice and/or over-the-counter anti-inflammatory drugs, consider using a compression bandage or compressive clothing to control the swelling. This phase usually lasts about 72 hours.
  2. Next, it heals – leave it alone, let it stabilise, though some gentle movement at this stage to keep the rest of the tissues healthy and encourage blood flow may be warranted. Depending on the injury, this may last a week or so.
  3. As the new tissue fibers start to thicken and strengthen, they will start to become stiff – controlled movement (i.e., rehabilitation exercises) is very important here, to encourage the fibers to rebuild in a way that is conducive to movement. Manual therapy may be used during this stage to encourage blood flow (which carries nutrients to the site, and waste products from the healing process away from the site) and to help direct the direction of the new fibers.
  4. Finally, the new strong tissue needs to be taught how to move with the rest of the joint or limb – in a formal rehab process, this is termed the “return to sport” phase and starts to look more like training pre-injury, though with more controlled movements and less chaotic elements (e.g. you might do a full football practice, but sit the game out). If you are not returning to a structured sport, your final phase of rehabilitating a sprained ankle might mean you do the same exercises you normally would in the gym but with lighter weights or shorter sets, or you might go for a run but only on a treadmill.

It might all sound like a lot of “fuss” for a sprained ankle – but as I said above, we need to re-think
this injury hierarchy that has us believe bone fractures are the most severe injury and that everything else will return to full function on its own. An untreated sprained ankle is more likely to be sprained again due to the instability in the joint resulting from the initial damage, and a wobble or fall can lead to worse than a sprained ankle.

The bottom line is: always seek professional diagnosis and treatment for a suspected sprain. If a medical professional or therapist acts dismissive of your sprain, or any pain or loss of function, you should seek another therapist! They might see dozens of “more severe” injuries in a week, but that doesn’t make yours less important.”

 

If you need help with your sport injury, do not hesitate to contact us for a free consultation

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