What is a Sprained Ankle?

A sprained ankle is an injury that occurs when the ankle rolls, twists, or bends. These movements put sudden strain on the ligaments that hold the ankle bones together and can stretch out or even tear them. Sprained ankles are a fairly common injury; over 25,000 people a day sprain their ankle regardless of their age or level of physical activity.

Ligaments are crucial in stabilizing the ankle, so when a ligament is stretched beyond its capacity, the ankle can no longer bear weight or maintain balance as well as before. The severity of sprained ankles varies; they can be mild twists that go away over a few days or complete ligament tears that take weeks or months of treatment. Most of the time, they are manageable injuries that require a few weeks’ worth of rest, therapeutic exercises, and immobilization through the use of bandages, braces, or splints.

Levels of Injury

The severities of sprained ankles vary depending on the level of pressure put on the ligaments and whether tears occur. When excessive force is exerted on the area’s soft-tissue structures during a sprain, you may hear a small “pop” and experience pain and swelling. Levels of sprains are as follows:

  • Grade 1: Slight stretching and some damage to ligament fibers
    • Symptoms: Minimal tenderness and swelling
    • Treatment: Isometric and therapeutic stretches, weight bearing as tolerated, usually no splinting or casting necessary
  • Grade 2: Partial tearing of the ligament; occasionally abnormal “looseness” of the ankle joint
    • Symptoms: Moderate tenderness and swelling, decreased range of motion, lack of balance or stability
    • Treatment: Immobilization with splint, physical therapy with range-of-motion and stretching/ strengthening exercises
  • Grade 3: Complete tear of the ligament
    • Symptoms: Significant swelling and tenderness, severe instability
    • Treatment: Immobilization, longer periods of physical rehabilitation, surgical reconstruction when necessary

Diagnosis

If you notice a tenderness in the ligament area, refer to a doctor, physical therapist, or other medical professional to assess the injury. Sometimes the physical pain or visual symptoms may be comparable to those that accompany a broken bone, so your doctor may suggest an X-ray to more accurately diagnose the injury.

A doctor may conduct a physical examination that involves moving the ankle and calf muscles to assess damage. These movements may be painful but are crucial in diagnosis the nature and severity of the injury. If the ligaments have completely torn, the ankle may become unstable and suffer damage to the surface of the ankle joint.

If the doctor suspects the injury may be severe, he may suggest an MRI after the swelling has gone down to more clearly examine the wounded area and confidently diagnose the injury.

Treatment

A variety of treatments options are available depending on the severity and nature of your sprained ankle, including both surgical and nonsurgical methods.

Nonsurgical Methods

The healing period for the average sprained ankle is about four to six weeks. Depending on the severity of the injury, a doctor may recommend crutches, and in almost all cases, doctors will recommend a wrap or brace to stabilize and protect the area. A ligament tear, even a complete one, does not necessarily require surgery and can be healed over time with simple immobilization methods.

For a Grade 1 sprain, use R.I.C.E. (Rest, Ice, Compression, and Elevation)

  • Rest your ankle by not walking or putting pressure on it
  • Ice regularly in order to keep the swelling down. Doctors typically recommend 20 to 30 minutes of application three to four times a day.
  • Compression using dressings, bandages, braces, or ace-wraps to support and protect the ankle
  • Elevate the ankle above heart level for at least 48 hours.

For a Grade 2 sprain, follow these same regiments but allow more time for healing. Immobilization devices or splints may also help expedite the healing process.

For a Grade 3 sprain, a short leg cast or brace can immobilize and heal the injury in two to three weeks. Surgery is rarely needed.

Above all treatment methods, rehabilitation and physical therapy are key to quickly and effectively healing a sprained ankle. Rehabilitation can include controlled movements of the ankle to increase blood flow and flexibility, ultrasound and electrical stimulation to decrease swelling, and lower-extremity endurance exercises. If the stress on the ankle is too great, water therapy is a great alternative that decreases the amount of pressure on the injury and makes these rehabilitation exercises easier.

Medication

Over-the-counter pain medication can help reduce any discomfort or swelling, especially nonsteroidal anti-inflammatory drugs (NSAIDs).

Surgical Treatment

Surgery is a rare treatment method for sprained ankles and is usually reserved for injuries that do not respond to immobilization or other nonsurgical treatments. Surgery is also a viable option for patients who experience no increase in stability or mobility after weeks or months of physical rehabilitation.

Types of surgery include:

  • Arthroscopy: An arthroscopy lets doctors see clearly the interior damage of the injury by use of a small telescope in order to most effectively diagnose the wound.
  • Reconstruction: A surgeon completely repairs the ankle with stitches, sutures, and/ or other ligaments and tendons in the ankle region.

Rehabilitation

Above all treatment methods, rehabilitation and physical therapy are key to quickly and effectively healing a sprained ankle. Rehabilitation can include controlled movements of the ankle to increase blood flow and flexibility, ultrasound and electrical stimulation to decrease swelling, and lower-extremity endurance exercises. If the stress on the ankle is too great, water therapy is a great alternative that decreases the amount of pressure on the injury and makes these rehabilitation exercises easier.

Recovery

All ankle sprains go through three stages of recovery:

  • Phase 1 (one week): Resting, immobilizing and protecting the ankle, reducing swelling
  • Phase 2 (one to two weeks): Restoring range of motion, strength, and flexibility through physical therapy and exercises
  • Phase 3 (weeks to months): gradually returning to physical activities that do not involve twisting, turning, or otherwise putting strain on the ankle

Prevention

The best way to avoid sprained ankles is to practice exercises that increase mobility, flexibility, and muscle balance. Some tips for preventing sprained ankles include:

  • Warm up and stretch before physical activity
  • Pay attention to uneven running or walking surfaces
  • Wear supportive footwear
  • Pay attention to your body’s warning signs; if you feel discomfort, adjust accordingly to avoid damage or injury.
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