Immediate Care of Acute Ankle Sprain

The most common injury to the ankle is a lateral, or inversion sprain.  This is when the sole of the foot rolls inward, thus injuring the lateral, or outside structures of the ankle. This type of injury compromises the ligaments of the ankle (most commonly injured: Anterior Talofibular, Posterior Talofibular, and Calcaneofibular ligaments) and the peroneal muscles that come down the lateral side of the leg.  This injury is usually sustained from either taking an awkward step (off of a curb, or onto someone’s foot, etc.) or from landing in an unstable way.  The peroneal muscles on the outside of the leg are responsible for pulling the foot from an inverted position to a neutral or everted position.  The ankle is most susceptible to a sprain when it is pointed and inverted.  Due to this mechanism we can conclude that the strength of the peroneal muscles have a big role in preventing this type of injury.

Whenever a ligament is sprained for the first time it causes a lot of swelling and bruising which results in pain and loss of function.  Swelling, or inflammation, is the body’s response to many injuries and it is not always bad. Inflammation allows for chemical mediators in the blood to be transported to the injury site to help heal the wound and eventually form a clot at the trauma site. The amount of swelling and inflammation can vary from individual to individual and also from injury to injury.

There is a common acronym that is used to treat acute extremity injuries, RICE.  RICE stands for Rest, Ice, Compression, and Elevation.  This protocol is usually used within the first 24-48 hours of the injury and helps to decrease the effects of the trauma. These steps encourage the swelling that has occurred after the injury to be pushed out of the joint and back into the cardiovascular system via the capillaries. Rest, as the name implies, is to stop using the affected extremity. This may mean sitting out of a game, or not finishing the walk to work if it is too unbearable. Ice works to decrease the amount of bleeding by causing the blood vessels to shrink (vasoconstriction), thus lowering the amount of fluid that can leak into the injury site. Ice is also used because it can numb the area and decrease pain at the injury site. A good rule of thumb is to ice for 15 minutes every hour (“15 on, 45 off”). You should not ice more than that, as frost nip and frost bite are possible when the skin is exposed to extreme cold for extended period of time. Under NO CIRCUMSTANCE should you place heat on an acute injury (injury less than 48 hours old). This can cause in increase in pain and swelling, thus lengthening the amount of time for healing to occur. Compression helps to move the inflammation out of the joint, which is imperative to promote return to function. It is important to not place compression too tight, or for extended period of time as the compression can impede normal blood flow to an extremity, or cut off nerve transmission. Elevation is imperative in treating lower extremity injuries due to the force of gravity which pushes the swelling downward, pooling in the lowest spot, which is the farthest away from the heart, making it harder to get reabsorbed by the lymphatic system. Getting the swelling, or inflammation, to go down and to decrease pain are always of utmost importance in any treatment plan. More severe ankle sprains can require that crutches or a boot is needed in order to prevent further damage that weight bearing exercises could cause.

Once the swelling has diminished, range of motion and strength exercises can be incorporated as tolerated. After strength (Examples of ankle exercises) is regained, balancing exercises are implemented to regain neuromuscular function. Plyometric and functional training are integrated in the last stages of treatment, just prior to return to full activity.  Example of general progression of exercises

The time it takes to return to normal activity can range depending on how severe the injury was and what your lifestyle demands may be. Returning to a sport or activity before the ankle is fully healed puts one at risk for continued discomfort and makes one more susceptible for recurring ankle sprains due to chronic instability.  For further information on management of ankle sprains check out the link below:


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