Mr P was a 26 year old Quantity Surveyor who presented to the clinic complaining of a “turned ankle”. He explained that his passion was Fell Running and that he spent all his spare time competing in races. He described how he had been participating in a “short” 16km event in the Lake District three weeks before.
Conditions were challenging as the ground was hard and greasy. Half way through the event he lost his balance and turned his right ankle. Mr P described how he felt a searing pain in the outer surface of his right ankle and for one brief second he thought he had fractured something. He was an experienced runner and realised that it was most likely an ankle ligament sprain, but driven on by a combination of determination, adrenaline and bravado he decided to carry on and try and run it off. He quickly realised that this was not going to happen and gingerly hobbled his way to the finish line.
Unable to drive home he found a B & B nearby and planned to RICE it (Raise, Ice, Compress and Elevate) but unfortunately he was unable to as they hadn’t any ice. The following day he went to the local A/E as his pain, bruising and swelling had markedly increased. He was examined by medical staff and diagnosed with a Grade I Inversion Sprain (these increase in severity from I to III, learn more below) and advised that it would probably take 4-6 weeks to recover.
For the first week he followed advice and continued to R.I.C.E. it and took regular non-steroidal anti-inflammatory drugs (N.S.A.I.D.s). By Week 2 boredom and frustration convinced him to try a (disastrous) short run. By Week 3, on the recommendation of a fellow runner, he decided to visit our clinic. It is essential to get treatment and rehabilitation right as poor management can lead to reoccurring sprains and altered biomechanics. We confirmed the original diagnosis and outlined our treatment aims.
This was initially focused on reduction of swelling, improving tissue quality and gently increasing range of motion (R.O.M.). Pain and swelling can also alter gait and so we commonly review foot, knee, hip and back mechanics.
The next element is proprioception, it commonly gets switched off or damaged during an ankle ligament sprain. It is an essential system and is the joint’s ability to tell where it is in time and space (it continually makes micro-corrections and acts like a cars computerised suspension, particularly over rough and uneven ground). Initially these exercises are non-weight bearing and when appropriate they advance to weight-bearing including Wobble Board use.
Mr P was a very compliant patient and followed the rehab program. After 4 weeks he was comfortably doing short training runs and by six weeks he was starting to ramp up his training in preparation for his first Fell Run three weeks later.
~ It is estimated that ankle injuries account for between one million and 1.5 million visits to accident and emergency each year in the UK.
~ A fifth of all sports injuries that present to A/E are ankle sprains.
~ 90% of these tend to be Inversion Ankle Sprains – the foot is inverted, falling inward. When this type of ankle sprain happens, the outer, or lateral, ligaments are stretched too far.
~ Eversion Ankle Sprains – The other type of sprained ankle is called an eversion injury, where the foot is twisted outwards.
Grade I Ankle Sprain – it causes stretching of the ligament. The symptoms tend to be limited to pain and swelling.
Grade II Ankle Sprain – it is more severe partial tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.
Grade III Ankle Sprain – they are complete tears of the ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.
Ankle Ligament Sprain Grading.