We offer an orientation guide so that you can obtain all the information to successfully address and recover from a sprained ankle as quickly as possible. We explain what a sprained ankle is, its mechanisms of action, types, symptoms and recommended treatment by recovery phases.
Each joint in the human body is designed to move in a certain way and in a stable manner. Among the structures that provide stability to the joint, we have the ligaments. When joints are forced to move from a position where the joint was not created, tears occur in these ligaments; what we know as a sprain or sprain. The ankle joint is the most commonly sprained joint in active people. This article is dedicated to the lateral collateral ligament sprain.
- On the one hand, a mild or moderate grade I or II external collateral ligament sprain (acute state or recently done)
- On the other hand, the treatment I recommend in case it has become chronic and it is an old or “badly healed” sprain.
These two cases are what represent 90% of sprains that must be approached and treated with physiotherapy, since grade III or severe sprains are treated with massive ligamentous rupture and are unusual, they are caused by high-energy trauma and they usually require surgery to restore the ligament.
Now let’s start at the beginning…
What is an ankle sprain?
An ankle sprain is a distension, or excessive elongation with or without rupture of the ligaments that are related to the ankle joint (joint complex that joins the bony elements of the tibia, fibula, talus and calcaneus to each other)
The ligaments found in the ankle fulfill the function of stabilizing the joint, the most important being the ones that are mostly affected in sprains , are the external collateral ligaments (LLE), specifically the anterior talofibular ligaments, posterior talofibular ligaments, and Calcaneofibular, deltoid or internal ligament is much less affected by sprains. (Internal Lateral Sprain)
The ankle joint is made up of 3 bones: the tibia, the fibula, and the talus. The ligaments that give lateral stability to the joint are the following:
- anterior talofibular ligament
- calcaneofibular ligament
- Posterior talofibular ligament
In addition, we have 3 muscles that contribute to the stability of the joint (perform the eversion of the foot). These are:
- Short fibular
- fibular longus
- anterior fibular
The mechanism of action of an ankle sprain or sprain.
It is a movement in which the ankle makes an inversion (movement of bringing the sole of the foot inwards) that puts the ligament under tension and stretches or partially breaks it. The most stable position of the ankle is during the dorsiflexion movement (toes up). Towards plantar flexion (toes down) the talus is displaced anteriorly and stability is lost.
If inversion and internal rotation of the foot are added to this plantar flexion, the aforementioned ligaments end up breaking or distending and an sprain or sprain occurs (closed injury to a joint due to a sudden turn, which causes a brief subluxation).
The anterior talofibular ligament is the weakest, so it is the first to be injured. The calcaneofibular and posterior talofibular ligaments are injured as the force with which these movements are performed increases.
Classification and differential diagnosis of an ankle sprain
Sprains are classified according to the severity of the injury as follows:
Grade 1 – MILD: Only a stretching or distension of the ligamentous fibers occurs.
Grade 2 – MODERATE: Partial tear of the ligamentous fibers.
Grade 3 – SEVERE: Considerable or complete tearing of the ligamentous fibers.
1) Grade I sprain: Mild or moderate
Slight distension that is solved with physiotherapy treatment in an agile and simple way, it is not necessary to immobilize it and the treatment must be early. 1 to 2 weeks in length.
It is a mild sprain , in this case the patient can continue walking with slight discomfort, as well as the inflammation, which is also mild and on many occasions there is no bruising. This injury is also known as a grade 1 sprain .
- Ligament stretching, usually the anterior talofibular
- spot sensitivity
- No foot laxity
- The patient retains a normal gait pattern as the ability to support body weight with the foot is preserved
- Little or no edema.
- Recovery in 1-2 weeks
2) Grade II sprain: Moderate
It is a ligamentous distension with partial rupture, it does not need immobilization, with early physiotherapeutic treatment and duration of 2 to 5 weeks.
The patient who suffers this injury can walk with great difficulties and pain, in addition the edema or swelling appears almost at the time of the injury, the hematoma that is produced by the fiber breakage is also evident and appears quickly.
- Partial tear of the ligaments, usually the anterior talofibular and calcaneofibular
- Punctual and diffuse sensitivity\
- Mild to moderate laxity
- Altered gait pattern: the weight of the body is avoided on the affected foot. Pain occurs with full body weight support. May require some walking aid (eg crutches) for ambulation.
- Mild to moderate edema.
- 2-5 weeks of recovery.
3) Grade III sprain: Serious total rupture of the ligament
Severe sprains or grade 3 sprains require surgical treatment, it is important to immobilize them and they will require significant rehabilitation treatment. 3-6 months of recovery, the edema and hematoma are evident from the first moment, in addition, the person will not be able to walk after the sprain since the pain and instability make it impossible.
It is usually the product of high-energy trauma, as a result of a major accident (traffic accident falling from a considerable height. It is usually associated with a fracture dislocation of the ankle joint. This will increase the time and difficulty of rehabilitation.
- Significant ligamentous tear, which may involve the anterior talofibular, calcaneofibular, and
- posterior talofibular.
- Punctual and diffuse sensitivity
- Moderate to severe laxity
- The gait pattern is altered; but in this case ambulation is almost impossible without the help of a walking aid
- severe edema
- Periarticular hematoma (due to broken capillaries)
- 3-6 months of recovery.
What is a Grade 1, 2 and 3 Ankle Sprain?
This video explains the classification of the degree of ankle sprain and its implications.
How to know if you have a sprained ankle and how serious it is
What you should do to know if you really have an ankle sprain and how serious it would be.
Why NOT immobilize a mild or moderate ankle sprain?
Understanding what an ankle sprain is and how it heals is necessary to understand why total immobilization with a cast or cast is only detrimental to the healing of this type of ankle injury, favoring sequelae or chronification of this sprain and making it easier for it to become a repetitive sprain.
When a mild or moderate sprain or strain of the ankle ligaments is caused, partial mobility is necessary during the healing process. A fact that is achieved by applying a functional bandage that allows partial mobility, even moderate exercise , while the ankle decreases its inflammation and heals it.
With a functional taping, posterior ankle rehabilitation is much less necessary, less proprioception is lost , there is less tendency for ligamentous or ligamentous laxity, and subsequent ankle instability.
The main differences between a mobilized and an immobilized ankle sprain (although this applies to the vast majority of injuries) is the recovery time , thus, a muscle that has not been immobilized can reach normal levels after a week of work, however, if the muscle has been immobilized it will need at least 3 weeks, this is more true the younger the person is, since in older people the times will increase.
We know that the speed of tissue regeneration is directly related to the aerobic metabolism in the injured tissue , so the more the area moves (activity in a non-immobilized injury), a greater supply of oxygen is going to be required, and therefore to have a higher regeneration.
The mobilization of an injury will generate an initial worsening of the hematoma, but otherwise it will generate a series of circumstances that will favor this regeneration, such as the increased flow of blood, which will increase the number of inflammatory cells, that will destroy the damaged tissue, in addition there will be a more intense regeneration of new apillars.
These are some of the reasons why it is better to mobilize a sprained ankle, but this does not mean that we should go out for a marathon run or play a basketball game, we must bear in mind that it is necessary to reduce the intensity of the activity since the tissue is damaged.
Treatment of a sprained ankle. (Grade I-II Mild-Moderate)
Recovery from a lateral ankle sprain must be careful, mainly because the healing phases and the duration of each one must be respected.
Treatment and recovery of a sprained ankle
The treatment is described in its acute phase, and in the recovery or rehabilitation phase, through exercises, functional bandages, massages and stretching, as well as the application of a clay plaster.
1) First phase: treatment for an acute ankle sprain. (first 24-72 hours)
A mild-moderate sprain as a general rule, after performing a person can feel great pain and functional impotence, they will not be able to walk without supporting the foot and will notice that it swells quickly, in the mildest sprains you can end up walking despite the discomfort and the pains and inflation.
- The application of ice is the treatment that should be followed as the first measure in all cases, it is important that it is applied in the first moment after it is done because it will reduce the edema or swelling that will form, so discomfort and pain will be reduced. The great advantage of early application of cold compared to anti-inflammatories is that it will not limit the positive inflammatory reaction (the arrival of inflammatory substances to the area of injury is what allows the damaged tissue to be replaced by new tissue and healthy) This normal and necessary inflammation reaction is eliminated if we use anti-inflammatories, which certainly reduce pain in the first moments, but do not allow the tissue to recover adequately and for that reason exponentially increases the risk of chronicity.
- Maintain function of uninjured tissues and overall body condition: The person is encouraged to begin standing on the foot as soon as pain is bearable, to stimulate circulation and maintain function of uninjured tissues. Also, the rest of the body should not be neglected. The injury was only to the foot! Cardiovascular exercises (bicycle or therapeutic pool races) or exercises to strengthen the lower and upper limbs can be performed normally as long as they do not cause pain.
- Control of inflammation and limitation of pain: Inflammation is a completely natural and necessary process, but it must be controlled to prevent improper healing. In addition to ice , I recommend three important interventions in this first phase to reduce edema, prevent relapses or repetitions of the sprain and ultimately to recover quickly and safely.
1) Pumping maneuvers to reduce edema and promote blood evacuation after an ankle sprain
This shows how to perform a pump-type massage to ensure that the bruise that occurs after an ankle sprain is more easily absorbed, facilitating the mobilization of the ankle and that the patient suffering from this sprain can start stepping as soon as possible possible. Being able to step on as soon as possible when the pain allows it, will facilitate the healing of the ligament to be more elastic, more resistant and less painful as long as a functional bandage is subsequently applied so that there is no danger of the ankle spraining again and a relapse occurs.
The hematoma and edema will cause pain and as the volume increases they also cause limitation of mobility, so it is interesting to reduce them in order to start moving the ankle as soon as possible.
There are multiple maneuvers that will pump the excess fluid in the joint and are therefore good for these cases. A good measure is to activate the muscles . When the leg muscles are activated, they help the venous return against the gravity, massages can also be applied, either an evacuation and circulation stimulation massage or a manual lymphatic drainage massage .
In addition to the measures to reduce edema, we can carry out measures to prevent the formation of edema, some of them are resting with the leg affected by the injury in a downward position, that is, raised, and it is also common the application of a circular bandage so that the edema does not grow too much, this bandage requires a lot of vigilance and special care so that it does not generate a strangulation of the blood vessels and thus produce more complicated injuries caused by the lack of blood supply in the foot.
2) Second phase of recovery from a sprained ankle. (3-10 days)
- Prevent additional injuries: this objective is continued in this phase, since the tissue that has been formed to replace the injured tissue is weak. Any extreme activity can cause re-injury, so it should be avoided. It is achieved with the continuation of the functional bandage.
- Reduce pain and inflammation and promote tissue repair: the use of heat increases blood flow and increases metabolism; which accelerates tissue repair processes, decreases inflammation and produces analgesic effects.
- In this phase, in the case of sports rehabilitation, we can walk fast and even do an easy run between 7-10 days depending on each case.
- In this phase we can begin to perform mobility recovery exercises.
- Exercises can be performed on unstable platforms with bipodal or unipodal (proprioceptive) support at the beginning level.
3) Third phase of recovery from a sprained ankle. (10-20 days)
- Restoring the configuration of the tissues: the evolution of the tissue produced can progress to become hard, which makes it prone to re-injury. With the Cyriax deep transverse massage these tissues can become more elastic.
- Reestablish normal ranges of motion, muscular power, neuromuscular control, muscular resistance, proprioception, agility and coordination: the application of exercise and stretching in this case are important. The increase in activity will allow us to recover the strength and stability of the foot, and the stretching will give it the flexibility lost due to the limitation of movement in the previous phase. Important proprioceptive exercises, which will retrain the brain for greater stability.
- In this phase, in case of sports rehabilitation, we can run between 12 and 20 days.
- Low intensity bouncing or jumping exercises for the ankle to adapt to the body load (without pain).
Treatment for a chronic or “poorly healed” ankle sprain
A mild or moderate ankle sprain that has not been properly healed can cause chronic problems that are usually very common if there have also been several sprains in the same joint.
In these cases, it is important to go to a physiotherapist who specializes in musculoskeletal injuries to evaluate the problem and treat it properly.
In general, when there is a chronic sprain problem, it is usually due to two main factors:
- Adhesions in the ligament due to poor healing.
- Joint blocks for sprains of the external collateral ligaments by inversion mechanisms, generally by blocks of the talus.
Summary and Conclusion of the article on the treatment of an ankle sprain
In conclusion, the ankle sprain must first be well evaluated, diagnosed and always addressed by a professional, because otherwise the poorly healed sprain becomes chronic and repetitive when returning from work, sports or life. Below we review some important aspects that you should consider if you have suffered an ankle sprain:
- It is a movement in which the ankle makes an inversion (movement of bringing the sole of the foot inwards) that puts tension on the lateral or external ligaments and stretches or partially breaks them.
- The anterior talofibular ligament is the weakest and the one that suffers the most damage or injury.
- The sprain grade I, II are solved directly with Physiotherapy, in the sprain grade III requires surgical intervention.
- The application of cold or cryotherapy in an acute stage is beneficial to control inflammation.
Prolonged immobilization of an ankle sprain is harmful since it does not favor the physiology of the tissues, it creates a less resistant and elastic scar, added to this, it creates muscle atrophy and the rehabilitation will be longer.
- For the reestablishment of the collagen fibers, reduction of pain once the inflammation has diminished, it is important to apply the Cyriax deep transverse massage.
- Other techniques that favor the sprain are functional bandaging as well as kinesiotaping or neuromuscular bandaging, both to restrict unwanted movements in the ankle and to promote lymphatic drainage.
I hope that this extensive article has been useful to you, and that in case you know of someone who has had an ankle sprain, you recommend reading this article and, on the other hand, going to a physiotherapist, since he is the best professional to recover from. after this injury.