Ankle Sprains are among the most common sporting injuries (Halabchi & Hassabi, 2020) and have a particularly high incidence in sports such as basketball, netball, Australian rules Football and soccer
Ankle injuries are often seen as innocuous injury however left untreated or are not rehabbed fully can cause persistent pain or long-term ankle instability leading to decreased performance and increased risk of future injury and even increased future risk of ankle OA (Herzog et al., 2019).
So what is the best management for ankle sprains and what does a successful rehab program need to achieve?
Acute Soft Tissue Injury Management
There have been many acronyms guiding acute injury management from ICE to RICE then to PRICE and POLICE, but the current best practice for acute injuries is to follow the guidelines of PEACE & LOVE (Dubois & Esculier, 2020)
For the first 2-3 days PEACE
Protect
Unload the ankle to minimize bleeding and reduce the risk of aggravating the injury. However, rest should be avoided as prolonged rest can reduce tissue strength and tissue quality.
Elevate
Elevate the limb higher than the heart to promote blood flow back to the heart to reduce swelling.
Avoid Anti-inflammatories
The Various phases of inflammation are very important to help repair damaged soft tissues, thus inhibiting this may negatively impact long-term tissue healing, especially if used for prolonged periods or at an increased dose. Therefore standard care of ankle sprains should not involve anti-inflammatories.
The role of ice in the management of soft tissue injury is also being questioned. High use of ice could potentially disrupt the inflammatory process and reduce tissue healing. Ice should be only used for pain reduction if needed
Compress
Compression has been shown to reduce swelling in acute ankle injury reducing blood pooling in the ankle. Think flight socks or tub grip. Even compression bandaging can also be super helpful to reduce swelling in your ankle. see example here
Educate
Seeing a healthcare professional to give you a plan and help you understand the injury can help get an optimal recovery outcome.
This may be an INITIAL Assessment at MOVE Sports Physio in Geelong/ Newtown in the session we will:
Complete a thorough assessment, this may include specific strength assessments, physio tests or refer for scanning if indicated.
We use our HANDS - hands on skills, and manual therapy to reduce your pain and calm your system down so we can help you get MOVING! Now don't get us wrong, this doesn't mean that's all we do. We are also evidence-based and will also provide you with loading strategies to build your capacity.
We get you MOVING with confidence again!
Additional EXTRAS at a session with
You will leave your session with a clear plan to get MOVING!
You will gain an individualised home program, specific to your body and your needs and access to our MOVE app.
We can complete specific strength assessments to get a baseline of your abilities.
We will send you and your healthcare team a PLAN to get moving.
Your clinician will check in with you regularly to ensure we are on the right path.
After this acute soft tissue injuries need LOVE
Load
Optimal load without exacerbating pain promotes repair, and remodeling and builds tissue tolerance, as well as improves the capacity of tendons, muscles, and ligaments. Therefore an active approach to recovery should be adopted as early as possible.
Optimism
A positive outlook can have a surprisingly big impact on recovery from injury. Thoughts, fears and emotions are even thought to explain more of the variation in symptoms following an ankle sprain more than the degree of injury. Therefore try to adopt a positive mindset and do things to help you get in a good frame of mind.
This one is a funny one, but actually really important in your overall recovery outcomes. Mindset matters
Vascularisation
Pain free aerobic exercise should be adopted early to promote blood flow and tissue healing, this has been shown to improve physical function and reduce pain. In non-fancy terms, get blood flow to the body and injured area, this helps deliver oxygen to the site and nutrients to help the healing process.
Exercise
Following an injury we need to restore strength, stability, range of motion and proprioception. A targeted exercise program is key to targeting these areas and restoring back to full function.
Again something your physio will provide to you after a consultation. We know after much research that this step is the most important in getting back to the movement you love.
Other important factors for optimal recovery following soft tissue injury:
Sleep
Sleep is a key to facilitating optimal tissue recovery. Reduced sleep can impact hormone balance and tissue recovery leading to less optimal healing outcomes (Lamon et al., 2021).
Alcohol consumption
Alcohol consumption impacts the body's healing process in a multitude of ways and has huge negative effects on recovery from injury. Alcohol reduces sleep quality, it is a vasodilator (makes the arteries and veins dilate therefore more blood can flow through) and therefore has increased the swelling, alcohol also drives up our inflammatory response which will increase tissue sensitivity to pain. On top of this impaired judgment and increased risk of further damage (Barnes, 2014).
Muscle pump
To help reduce swelling and make sure our body can remove damaged tissue and send the necessary building blocks to the damaged area we need to promote blood flow. In our lower limb this blood flow is aided via what is called the muscle pump in which when we contract our calves this squeezes blood back to our heart promoting blood flow. When we are injured we are not moving as much as normal therefore blood can pool and increase swelling. Performing calf pumps in sitting or lying will help promote blood
Great! So now we have covered the most up-to-date evidence for soft tissue injuries, keep reading to find out what the specifics we recommend you get started with your ankle rehab!
ANKLE SPECIFIC REHAB
After an ankle injury, we see many deficiencies that need to be addressed to make a full recovery and reduce future risk of injury. We know once you roll or injure your ankle you are likely to do it again, and in terms of long-term outcomes, if your ankle isn't 100% when you get back to sport/ activity - your longer-term risk of osteoarthritis also increases.
Early Exercise Program for an Ankle Sprain
To address a reduced range of motion:
After an ankle injury, it is normal for your joint to feel stiff / swollen or tight.
Knee to wall without band. This exercise tries to reduce stiffness in the joint capsule which can be a source of pain when returning to activities if not addressed.
(See below for your whole program)
To address strength losses
Due to decreased loading and effects of pain inhibition and possible damage sustained in the injury, we need to get stronger in your ankle and calve complex. This is a really good place to start and you can do this a lot during the day. Start with 10 reps 5-8 x per day. The more load early on the better (just watch your swelling) - if your ankle blows up after, back off a bit and give your injury some more PEACE.
Calf raises
Ankle inversion and eversion --> check out the program below.
To address decreased proprioception - Now this is something a lot of people miss in their rehab. Often mechanoreceptors are injured when you injure ankle ligaments. Mechanoreceptors are small receptors that tell your brain where your body is in space. It is really important in early-stage rehab to change these little critters and improve your proprioception. (knowing where your body is in space).
We do that by pushing your balance. Try this as a start -
Single leg balance exercise. Remember this exercise needs to feel challenging, this can be done on the ground and then progressing to a more unstable environment a rolled up towel, piece of foam or pillow.
Single leg balance exercise
See below for ideas you can progress each of your balance and proprioception.
Increase the challenge Single leg balance on foam
Single Leg Balance Dura disc
Single Leg balance dura disc and ball - Add more chaos
Ok, so that gets that basic started. These exercises are great to get you started, but we would strongly recommend you get your ankle looked at, really structure and nail your rehab to ensure you don't re-injure in the future and get back to your goals ASAP! Even one session to assess and ensure your rehab is specific to your ankle, foot type, injury and sport can make all the difference!
Click below to get your program to get started :
Please get in touch if you have any questions about your specific injury and how to get back in the game ASAP!
References:
Barnes, M. J. (2014). Alcohol: impact on sports performance and recovery in male athletes. Sports Med, 44(7), 909-919. https://doi.org/10.1007/s40279-014-0192-8
Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med, 54(2), 72-73. https://doi.org/10.1136/bjsports-2019-101253
Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop, 11(12), 534-558. https://doi.org/10.5312/wjo.v11.i12.534
Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17
Lamon, S., Morabito, A., Arentson-Lantz, E., Knowles, O., Vincent, G. E., Condo, D., Alexander, S. E., Garnham, A., Paddon-Jones, D., & Aisbett, B. (2021). The effect of acute sleep deprivation on skeletal muscle protein synthesis and the hormonal environment. Physiol Rep, 9(1), e14660. https://doi.org/10.14814/phy2.14660
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