Our Physiotherapy team is anticipating numerous ankle sprain injuries presenting to the studio in the winter months during winter sports. Some ankle sprains are quite simple and easy to manage, while others can be quite complex injuries that require careful intervention.
What can go wrong?
- Most commonly, ligaments on the lateral aspect of the ankle are overstretched and may partially, or totally, tear.
- Ligaments sitting just above the ankle that form part of the ‘syndesmosis’ may tear producing what we often refer to as a ‘high ankle sprain’. This is a serious injury.
- The sudden movement to the ankle joint may aggravate cartilage within the joint resulting in an ‘osteochondral lesion’.
- Other structures must always be considered including bone. We’ve all heard of someone who has fractured their ankle.
What do we do about it?
An immediate appointment with a Physiotherapist or Sports Doctor is the best place to start. Establishing the diagnosis, or attempting to, is the required initial step. Referral for scans may be involved.
For example, one of the Hawthorn physios recently suspected a syndesmosis injury and then arranged an MRI. The MRI confirmed the diagnosis. Had this been missed, the patient would have experienced ongoing problems as it requires different intervention to the common ankle sprain. Obviously, a substantial fracture will result in an immediate referral to a local Emergency Department.
Should conservative management be the most appropriate way to proceed, regular icing should be done for the first few days. Supporting the painful joint with taping or bracing can assist with pain levels, control of swelling and promote early heeling. More serious injuries may mean a CAM-walker is necessary.
Are crutches required?
If pain levels are very high, crutches should be used to avoid weightbearing for 24 hours. Ongoing non-weightbearing may promote joint stiffness and therefore partial weightbearing with crutches can be part of an effective return to normal walking.
Appointments with your Physio are required to:
- Mobilize the joint to limit stiffness and clear inflammation
- Advise on progressive exercise rehab to regain strength in the supportive muscles as well as regain proprioception
A clear understanding on the end goal is always warranted as your Physio will need to set a pathway for you to return to activity.
Doing too much too soon may produce chronic inflammation in the joint, while under-doing rehab will increase the risk of reinjury.
The ‘difficult ankle’ is known in the Physiotherapy industry as being one that was not properly rehabilitated and often requires more serious medical interventions to manage. Obviously avoiding this is best case scenario.
Glenn McKernan
Director & APA Sports Physiotherapist
Evado Studios Hawthorn, Clayton & Cheltenham