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Sprained Ankles

 

Ankle sprains are the most commonly experienced athletic injury. A sprain occurs when the stout ligaments connecting bones of the ankle are either stretched, partially ruptured or completely torn. Athletes experiencing ankle sprains commonly remark that they felt their ankle turn under. This is associated with an almost immediate onset of swelling along the outside of the ankle and pain. If treated quickly and appropriately ankle sprains can heal well, returning the athlete to competition within a matter of days. If ankle sprains are ignored, enormous swelling occurs keeping the athlete out of competition for weeks to months.

Definition
An injury to the tendons, muscles, or ligaments around an articulation (joint) - in this case the ankle.

Causes
Trauma directly to the joint causing the joint to move into a position in which it was not designed to move. People with loose ligaments and stretched muscles on the sides of the ankles, weak leg muscles, prior ankle sprains that were incompletely rehabilitated and bad balance are especially prone to ankle sprain. This is because their ankles tend to roll outward, either overstretching or tearing the ligaments.

Symptoms
Joint pain or muscle pain
Swelling
Discoloration of the skin, especially bruising
Impaired joint function

Considerations
First you need to determine if it is a strain or a sprain. A strain is a pulled muscle. A sprain involves stretched or torn ligaments around a joint. Both cause pain and swelling and bleeding under the skin. If the pain and swelling have decreased 48 hours after a sprain, move the affected joint in all directions. However, keep pressure off the injured area until the pain subsides usually 7 to 10 days for mild sprains and 3 to 5 weeks for severe sprains.

First Aid

  1. Restrict the movement of the affected area. Use a splint if necessary (see how to make a splint).

  2. Avoid activities that cause pain or swelling. Rest. Rest allows the tissue to heal.

  3. Apply cold compresses immediately (this will help reduce swelling). Avoid using ice directly on the skin.  Ice numbs the pain and minimizes swelling. Apply an ice pack for 15 to 20 minute every few hours for the first two days. If the ankle is allowed to swell initially after the injury, the time table to recover is markedly delayed making immediate care the most important aspect of ankle injury.

  4. Bandage the affected area firmly but not tightly for at least two days to control the bleeding and swelling. ACE bandages are good for this.

  5. Raise the ankle above the level of the heart--especially at night while sleeping. It will reduce internal bleeding.

  6. Think RICE for sprains (R = Rest, I = Ice, C = Compression and immobilization, E = Elevate the area).

  7. Do not give the victim anything by mouth if a severe injury is suspected. Do not ignore pain that persists. Rest any body part that is in pain.

Self-Help Treatment Measures Sometimes Include:

  1. Intermittent application of ice to the areas for the first 24 hours to 48 hours following the injury

  2. Keeping the part elevated (above the level of the heart, if possible) to decrease swelling

  3. Minimizing use of the joint, if it causes any pain

  4. Use of anti-inflammatory medication such as aspirin or Ibuprophen or Naproxen (Ask your pharmacist to explain the benefits, risks and costs of this option if you consider using medications.)

Call Immediately For Emergency Medical Assistance if
a) a broken bone is suspected or if there has been a serious injury or persistent pain.
b) there is an audible popping sound and immediate difficulty in using the joint.

Prevention
Prevent sprained ankles with strengthening and balancing exercises. To strengthen your evertor muscles (those that lift the outside edge of your foot), loop a bungee cord (without the hook), any stretchy tubing or band or a pair of pantyhose around both feet while sitting or standing. Roll the outside edges of your feet upward. Hold for a few seconds. Repeat. Gradually increase to 10 repetitions. Do this exercise at least twice daily. Another helpful exercise to just try to maintain balance as long as possible while standing on one foot.

Light Therapy
More and more prevalent in sports medicine for treatment of this sort of injury (and many others) is Red and Infrared Light Therapy. The light works on a cellular level to hasten the body's natural healing process. Light therapy is used as a part of a traditional treatment program. These can be found in training rooms of virtually all professional sports teams and physical therapists around the world including the US Olympic teams. The first large, multi thousand dollar units have been replaced by small hand held units that are available for under $250.
References: The fully documented, "Effect of NASA Light-Emitting Diode Irradiation on Wound Healing" Light therapy as used in sports therapy here.


How Should I Rehabilitate My Ankle?
Rehabilitation can begin a few days after the injury, when the swelling starts to go down. There are three goals to aim for in rehabilitation.

1. 
Restore motion and flexibility.  Gently move the ankle up and down. After 5 to 7 days, start restoring motion to the hindfoot by turning the heel in and out.

You should also begin to restore flexibility to the calf muscles. One way to do this is to face a wall with one foot in front of the other and lean forward with your hands on the wall, bend the front leg while keeping the back leg straight and both heels on the floor. Lean forward until you feel a gentle stretch, and hold for ten seconds. Switch legs and repeat.

2.  Restore strength.  After 60 to 70% of the ankle’s normal motion has returned, you can begin strengthening exercises using a rubber tube for resistance. Fix one end of the tube to an immovable object like a table leg, and loop the other end around the forefoot. Sit with your knees bent and heels on the floor. Pull your foot inward against the tubing, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.

You can also sit on the floor with your knees bent and the tube looped around both feet. Slowly pull outward against the tube, moving your knee as little as possible. Return slowly to the starting position. Repeat with the other foot.

3.  Restore balance.  As strength returns, balance is restored by standing on the injured leg, hands out to the sides. You may want to warm the ankle before doing these exercises by soaking it in warm water. Warmed tissue is more flexible and less prone to injury. Use ice when finished with the exercises to minimize any irritation to the tissue caused by the exercise.

When Can I Return To Sports?
Return to sports only after you have met these goals:
1.  You have full range of motion in all directions (up and down, side to side, and in and out).
2.  You have good strength in all muscles around the ankle.
3.  You have good balance.
4.  You have no pain or swelling with exercise or activity.

Should I Use A Brace When I Play Sports?
Taping the ankle or using a brace for support can help prevent re-injury. There are many different types of braces, some made of neoprene, some made of elastic material, and some have extra straps or ties for support. Select a brace that feels like it gives you the best support for the activity you want to do. Braces with straps or ties generally provide greater support. Never use a brace that is too tight.

Remember, a brace helps support strong muscles but should never be used as a substitute for a strengthening program. Continue to do strengthening exercises as you return to sports.


Taped to prevent re-injury

How to bandage a sprain
1. Wrap a sprained ankles with a compression bandage in a figure 8 pattern. Make two loops around the instep, then stretch bandage diagonally across the foot.
2. Bring the bandage around the ankle to the front of the foot. Then wrap it diagonally across the foot.
3. Continue wrapping the bandage in figure 8 turns. Each turn should overlap the previous turn by about three fourths of the bandage’s width.
4. When the foot and ankle are wrapped, secure the bandage with a pin. Leave toes bare. If they become numb or discolored, the bandage is too tight.


If you continue to have problems with the ankle after resting it, icing it, bandaging it and elevating it, you may have a bigger problem than just a sprain. You may need to go to the doctor and see if there is further damage. But for the most part, these steps will help you heal a sprained ankle quickly and safely.

Another helpful article: Preseason Training Essential for Preventing Ankle Sprains  (on WebMD -- leaves USGyms)


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