By Cary Groner
You’re on a playing field, a volleyball or basketball court or running in the hills. You land a little off-balance, or your foot comes down on the side of a rock. Suddenly — wham! — your ankle rolls out, the pain shoots up your leg and you’re on the ground.
Ankle sprains are among the most common sports-related injuries, accounting for 1.2 million healthcare visits in the United States every year. Given that people don’t often seek medical care for minor sprains, the actual number is almost certainly higher.
Sprains usually heal in a few weeks. But in up to half of cases, people never fully regain their strength and flexibility. This is known as chronic ankle instability (CAI), and it can hamper an active lifestyle for many years.
Most ankle sprains are “inversion” sprains. This means that the ankle rolls outward and the foot turns under, so that the bottom of the foot (the plantar surface) turns toward the body’s center line. When this happens, the ligaments connecting ankle and foot bones are overstretched or even torn. Blood vessels are damaged as well, resulting in immediate pain and swelling.
Ankle sprains are categorized in three levels of severity, according to the National Institutes of Health:
If your sprain is severe enough to require medical care, a physician may order an X-ray to be sure your ankle isn’t broken. Fortunately, only about 15 percent of such injuries involve fractures. Your doctor may also want to confirm that the damaged ligaments haven’t pulled away any fragments of bone. Your doctor will also check to see if the articular surfaces of any joints (the part of a joint where the ends of bones meet) are damaged, an injury that can be hard to heal and may lead to osteoarthritis later (fortunately, that complication is much more common in fractures than in sprains). In severe cases, and when pain and other problems persist, your physician may order an MRI, which will provide a more thorough look at your ankle.
Quick treatment for sprains is important for several reasons. First, if you don’t control the inflammation that occurs immediately afterward, your body is more likely to form scar tissue, which is only about half as good at absorbing energy as ligaments are. Second, the sooner you reduce the pain and inflammation, the sooner you can begin exercises to regain strength and proprioceptive capabilities — that is, how you sense the ankle’s position in space. This is important because impaired proprioception is linked to repeated sprains and CAI.
The first treatment, no matter how severe the sprain, is rest, ice, compression and elevation, or RICE. It’s usually a good idea to take a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen to control the pain. Just be aware of your own body’s reaction to medication, as long-term use can lead to stomach problems, bleeding and other complications.
For grade 1 sprains, you may want to wear an elastic bandage or ankle brace to help support and stabilize the ankle for a few days. Ideally you’ll be walking normally within a week or so.
In more severe cases, and when ligaments are torn, it might be weeks before your ankle can bear your full weight again. Your physician may prescribe a lace-up or gel brace to provide support, and will likely recommend physical therapy to help you regain your strength and flexibility.
Your physical therapist will give you exercises to help speed rehabilitation. These typically involve working with an elastic band to overcome stiffness, improve range of motion and build strength. Other exercises may be targeted specifically to regaining and improving your proprioceptive capabilities. All of these together should reduce your risk of further sprains or of developing CAI.
In very severe cases, a surgeon may repair the torn ligaments, but this is usually unnecessary. Given an adequate period of immobilization, followed by careful and progressive physical therapy, most ligaments heal well on their own. If you’re still having significant trouble six to nine months after the initial injury, you may want to discuss surgery with your doctor, but in most cases it’s best to be patient and stay with your rehabilitation program.
People who have sprained their ankles are at higher risk than others to sprain them again — sometimes repeatedly — so clinicians and trainers have tips to help keep that from happening.
For instance, most experts say it’s best to avoid high heels — maybe forever. This is a matter of simple leverage; if your foot rolls over while you’re wearing flats or a low heel, there isn’t a lot of extra force put on the ankle. Raise that heel to two or three inches, however, and the lever action subjects your ankle to much more force and a higher risk of injury.
Research also shows that bracing can prevent re-injury, as well. In one study of high school basketball players, for example, those who wore ankle braces had only about a third of the sprain rate as those who didn’t (the braces didn’t decrease sprain severity, however). Another study in high school football players revealed similar statistics.
Experts aren’t convinced that it’s the support offered by the braces that decreases the sprain risk, however. Braces are associated with improved proprioception, by subtly calling the brain’s attention to the position of the ankle, and that alone may be enough to reduce risk.
Primarily, though, experts recommend common sense. Because ankle sprains are often caused by stepping or landing on an uneven surface that rolls the ankle to the outside, it’s a good idea to walk on even surfaces and avoid sudden cutting maneuvers until your rehab is complete and you’re confident that you’ve recovered your full strength and flexibility.
Published March 27, 2012.
Cary Groner is a writer based in the San Francisco Bay Area. His recent novel, “Exiles,” placed fourth on the Chicago Tribune’s list of the best books of 2011.