To talk about the physiotherapy treatment of ankle sprain we first have to know what a sprain is. In another post we have already talked about what the ligaments are and what their function is. Colloquially speaking of “twisted ankle” or “ankle bent” to refer to the sprain, an injury that affects the ligaments. In this case we refer to those of the ankle, but one sprain can affect other ligaments of another joint. Since the ankle is the most frequent sprain, it is usual that it is also the best known and the one that raises more doubts about which is the best treatment.
A good treatment of the ankle sprain should include measures to relieve pain and inflammation, promote rest and scarring of the injured ligament and stimulate the support, movement and exercise of the muscles and joints that are not affected by the injury.
Degrees of ankle sprain
In this type of injuries one or more ligaments are affected. The injury mechanism is usually a movement that goes beyond the normal range of movement of the joint. The ligaments are responsible for directing and limiting movement, so a movement in an abnormal direction or amplitude will cause damage of varying consideration to the ligaments. Depending on the severity of the damage, sprain classification is usually done.
The classification can be anatomical or pathological. In the anatomical classification , reference is made to the ligaments affected by the lesion, while in the pathological classification it is made depending on the severity of the damage caused. The latter is the most used, and is presented below:
Grade I sprain : distention or elongation. The ligament or ligaments are stretched, but without breaking fibers.
Grade II sprain : Desgaro or partial rupture. Some fibers of the ligament are broken.
Grade III sprain : Complete rupture of the ligament fibers.
Ligaments that are injured in a sprained ankle
The most frequent sprain is that of the external ligaments of the ankle
As you can see, in the foot, because there are so many small bones forming a large number of joints, there are also many ligaments connecting the bone segments. It appears marked in orange the external collateral ligament (‘lateral’ and ‘external’ are synonyms) of the ankle, and is composed in turn by several ligaments.
Rest : logically, do not support the affected foot until it starts recovering and progressive support is possible (first soft support, with the help of crutches, little by little, to make a more intense support). Rest as much as possible and move using crutches or canes. For this I recommend following the instructions in this article on the correct use of crutches and canes.
Ice : apply cold in the injured area . It can be ice cubes, or better, apply a special bag designed for this purpose ( cold-pack ). For sale in pharmacies and orthopedics, is filled with a gel that is cooled in the freezer and is moldable once it is cold, so that we can adapt the bag to the foot area we want. Another option is to use a bag of frozen peas, less showy but very effective, since it also allows adapting the bag to the surface to be treated. Eye !: The cold burns . It is best not to apply ice or frozen bag directly on the skin, but use a napkin or thin cloth to isolate the skin from direct contact. The applications will be about 10-15 minutes. After this time, remove the cold and let the foot rest a little (it is not convenient the cold very continued). If you want to repeat, do it again in 10-15 minute applications with breaks.
Compression : it is good to apply a compressive elastic bandage on the ankle and leg, to give stability to the foot in addition to avoiding excessive edema. The ideal would be to apply functional bandages, which allow a certain function of the ankle in addition to the support of the foot, which avoids loss of muscle strength and proprioception (below a little is said about the subject of proprioception).
Elevation : keeping the leg elevated at the moments when you are resting will help your rest and will prevent the increase of edema in the area.
For its acronym in English ( R est- I ce- C ompression- E levation), these guidelines are known by using the mnemonic RICE ( ‘rice’ would be the translation into Spanish), and are used to relieve many ailments in traumatology .
From physiotherapy, other techniques are also applied to relieve pain and inflammation (ultrasound, laser, pressure therapy, massage …), also compressive bandages and functional bandages are essential and, above all, it is very important to emphasize specific exercises for strengthen the ankle muscles . The objective is to selectively strengthen the muscles that are in the same area as the injured ligaments, in such a way that they will be strong and agile to respond in case of excessive stretching (repetition of the mechanism of injury that caused the sprain). In this way, the muscles could be said to act as ligament helpers, limiting the range of a movement that exceeds normal limits and can cause injury.
The functional bandage is a technique that allows to immobilize the area, to prevent damage from increasing, but allowing the foot to support. It can be removed and put, so it allows physiotherapy treatment, and allows walking, running, or even compete. It is a very good technique to keep the foot stimulated, to avoid losing strength and sensitivity, and promotes the early and effective recovery of this type of injury.
In addition, in sprains and other types of injuries, proprioception is frequently affected, that is, the ability of the joint to respond to quick and abrupt efforts. Therefore, a good recovery of this type of injury can not be made without specifically working on ankle procception. Here are some examples of exercises to train proprioception after an ankle injury.