with Dr. Richard Beauchamp M.D., FRCSC
An ankle sprain refers to an acute or sudden injury that results in tearing of any of the ligaments of the ankle. Ligaments are strong tissues that attach to the adjacent bones of a joint, providing stability and limiting excessive movement. Sprains are usually graded according to the severity of the injury, as follows:
Classification: Grade 1
This refers to a mild stretch of some of the ligament fibres only. The individual is able to initially walk on the ankle without much discomfort. There may be some swelling, but recovery is usually complete in a few days.
Classification: Grade 2
The athlete may feel a tearing sensation or “popping” effect. Since there is more trauma to the joint, there is often significant swelling in the injured area, sometimes appearing within minutes. Walking is possible, though very painful. These injuries may take 3 to 6 weeks to completely heal.
Classification: Grade 3
This injury usually involves a complete tear of all three lateral collateral ligaments. Fellow runners may also hear the popping sound of the ligaments tearing. The swelling may not be as dramatic because the ankle joint capsule may also be torn, thereby allowing the blood to dissipate and diffuse around the ankle, without forming a localized “lump.” The person cannot take any more than a few steps and will usually need help to walk. Complete ligament tears can take 6 weeks or more for the reparative process to occur, and surgery may be required.
More serious injuries do require a visit to your local emergency department or medical clinic, to determine if an x-ray is required (to rule out a fracture in one of the ankle bones). Your local clinic or ER department may refer to established guidelines such as the Quebec Protocol. Most people are not sufficiently trained to independently decide if an x-ray is needed.
New evidence suggests that faster healing and return to activity is achieved by more rapid mobilization following an ankle sprain. This means that in the absence of a complete tear of all the ankle ligaments (Grade 3) or a fracture (broken bone), early weight bearing and light running can be done after only a few days of rest. The lessening of the ankle swelling is a good indicator that you can begin gentle running. Sometimes an air cast or air splint gives additional support to make running more comfortable.
The initial management (first 12 to 24 hours) of an ankle sprain should involve resting the leg. This means staying off it as much as possible—no long walks or running for a few days. You should elevate the limb and apply an ice pack to the area as soon as possible after the injury. A lightly-applied compressive tensor bandage or wrap will also help to control excessive swelling.
During this initial treatment period, instituting some active range of movement exercises is probably one of the most important things you can do. While sitting or lying on your back, point your leg upwards and make gentle circular movements with your whole leg, working toward isolating your ankle movement. Try tracing imaginary figure-8 loops in the air. This helps maintain range of motion, decrease eventual stiffness and dissipate swelling. This exercise should be done three times a day for 5 to 10 minutes each time.
Physiotherapy is usually an integral part of the rehabilitation process for ankle sprains. This is particularly important if you suffer from “recurrent” ankle sprains (more than one or two ankle sprains in a two-year period). The therapy usually involves strengthening the everters or outside muscles of the ankle. It is equally or more important to stretch the Achilles tendon, since mild underlying heel cord tightness is a common finding associated with ankle sprains. Proprioceptive and biofeedback procedures are also useful.
Ankle sprains, if treated early and properly, will usually heal completely. If Grade 2 or Grade 3 ankle sprains are incompletely treated, the ligaments may become loose, resulting in chronic ankle instability. This poses a high risk for recurrent ankle sprains, which may require surgery to avoid the development of post-traumatic degenerative osteoarthritis.
Dr. Richard Beauchamp is an orthopedic surgeon based in Vancouver. He is the medical director of the Shriner’s Gait Lab at Sunny Hill Health Centre and a clinical professor in the Department of Orthopedics at the University of British Columbia. He is an avid runner and walker who has completed seven marathons.