A sprain is when a ligament is stressed or torn. A ligament is a strong fibrous tissue that connects bones. Their role is to avoid excessive movement [more than acceptable range of motion] and stabilize the joints.
You can sprain any ligament found in your body’s joints, but the areas most prone to injury are the joints in the limbs since these are most exposed during falls and trauma. The most common sites are the wrists and ankles.
What is a Sprained Ankle?
There are several bones in your ankle that are connected by ligaments. To be specific, the ankle joint is stabilized by a group of ligaments at both the ankle’s inner and outer sides. Most ankle sprains happen at the ligaments at the ankle’s outer side, caused by the ankle turning inward.
A sprain in an ankle happens when ligaments are stretched beyond their capacity. This may be caused by an awkward landing, moving around on an uneven surface, or anything that twists your ankle, such as tripping, falling, or someone accidentally steps or falls on them.
Sprains can be classified into three Grades:
Grade 1 Sprain [Mild]:
- The ligament is stretched
- pain is tolerable when walking
Grade 2 Sprain [Moderate]:
- there is an incomplete ligament tear
- there is moderate pain, bruising, and swelling
Grade 3 Sprain [Severe]:
- the affected ligament is completely torn
- there is severe pain, bruising, and swelling
- the ankle is giving out, making walking an impossible feat
|Parameters||Grade I||Grade II||Grade III|
|What happens to the ligament?||Stretching||Some tearing||Complete tearing|
|Loss of range of motion||Mild||Moderate||Complete loss|
|Loss of Strength||0 to 25%||25 to 75%||75 to 100%|
|Swelling||May not be present or slight swelling||Present (++)||Extensively swollen (+++)|
|Stability||Not reduced||Slightly reduced stability||Markedly reduced|
Signs and Symptoms of a Sprained Ankle
The presenting symptoms may vary depending on how severe the injury is. Some of these include:
- Pain, swelling, or both, at the affected joint
- Feeling or hearing a “pop” at the site of injury when it happened
- Too much instability of the ankle joint
- Decreased ability to sense when the ankle is moved passively
- Related joint symptoms such as stiffness, numbness, etc.
- Limited movement at the joint
- Restricted ambulation (which requires the use of an assistive device), especially at the onset
What Causes an Ankle Sprain?
Sprains are not uncommon. Since we move and work a lot, there are instances when too much stress is placed on a ligament causing it to stretch or tear.
These instances include:
- Exercise (including jogging and running)
- Repetitive motion
- Placing the body in awkward positions
- Accidents such as falls and slips
While anybody can have an ankle sprain at any point, certain risk factors increase the chance of you getting an ankle sprain. These include:
- Environmental Factors. Uneven and slippery surfaces increase the risk of accidents that might lead to sprains.
- Improper Footwear. Shoes that are not suited for the activity or those that don’t fit the wearer and high-heeled shoes, in general, make the ankles disposed to incurring injury
- Participating in Sports. Ankle sprains are very common in sports. Injury is common because many sports require agile foot movements, such as basketball, tennis, football, and soccer.
- History of Ankle Injury. If you’ve had a past injury to your ankle, there’s a greater chance for you to sprain it again.
- Lack of Warm-Up. Warming up prepares the body for movement. A good stretch increases your body’s range of motion and flexibility, reducing the likelihood of an injury.
- Using Improper Gear or Equipment. Ill-fitting and worn-out gear or sporting equipment will do more harm than good.
- Poor Conditioning. Being out of shape means that structures such as muscles and joints are not prepared to support and meet your body’s activity demands. Poor strength may cause damage to structures during repetitive motion and overexertion.
- Being Tired. Like lack of warm-up and poor conditioning, being worn-out would likely lead to utilizing a poor form. Moving with poor form increases the chance of getting injured and putting undue stress on structures.
A doctor will do a physical exam to rule out the other causes for the presenting symptoms. The doctor will check the range of motion and then likely ask you to point out where the pain is and rate it on a scale of 1-10. This, as well as physical inspection, will help them determine the location, nature, and extent of the damage.
To help in the diagnosis, a doctor may request for imaging:
X-ray: this technique produces an image of the bones of the ankle to rule out fractures.
Magnetic Resonance Imaging (MRI): if the data from the X-ray is not enough, a doctor might order this imaging technique, which produces a detailed view of the soft tissues of the joint to determine if there is a tear in the ligaments
CT scan is ordered to reveal the details of the integrity of bones [3-d images] of the joint to find out if there is a break in the bone
Treatment and Home Remedies
There are various treatment options for an ankle sprain. The approach depends on the grade or degree of ankle sprain and the phase of healing the ankle sprain is in.
Grade 1 and 2 ankle sprains are treated conservatively. Grade three sprains require surgical repair or reconstruction.
Management depends on the phase of the ankle sprain:
Protection Phase: the primary goal is the protection of the injured ankle.
- Perform RICE.
- Rest. Avoid moving the ankle, especially in movements that cause pain.
- Ice. Ice your ankle every two hours for 15 to 20 minutes during the first 24 to 48 hours.
- Compression. Use an elastic bandage to provide compression on the swollen ankle. Start wrapping from the foot towards the ankle. Ensure that there is proper circulation. Loosen the wrap if there is numbness or an increase in pain.
- Elevation. Position the swollen ankle above the heart level so that gravity can aid in reducing the swelling.
- Immobilize the ankle using commercially available wraps or splints.
- Gently move the joint to maintain its mobility and reduce pain.
- Perform simple exercises such as toe curls to help with blood circulation and keep muscle integrity
- When walking, introduce a little weight to the foot while using crutches
Controlled Motion Phase: the goal is to reintroduce movement while still protecting the ankle slowly:
- Continue wearing splints to protect the ankle as you increase the weight you’re putting on the affected foot.
- Apply massage to the ligament as tolerated
- Do simple exercises such as toe-curling and writing the alphabet in the air using the foot
- As more weight-bearing is tolerated, progress to exercises that focus on strengthening and improving endurance and stability
Return to Function Phase: the goal is to improve the overall function of the ankle through rigorous training
- Progress with strengthening exercises by providing resistance
- Progress to complete weight-bearing activities
- Do postural and balance training
You can take over-the-counter medication to manage pain and reduce swelling.
A physical therapist can help with designing activities to help improve flexibility, stability, balance, and strength.
- Prevent re-injury. If you are involved with sports, appropriately wrap, tape, or splint to reduce the likelihood of reinjury. Avoid wearing high heels unless necessary.
- Be active. Exercise regularly. This is better than doing aggressive activities but on an irregular basis. Maintain flexibility and muscle strength. Include balance exercises and stability training in your routine.
- Be cautious. Be mindful of the surface you are walking on or performing exercises on.
- Do not skip on warm-ups. Make sure to do stretches to prepare your body before a workout
- Take breaks. When you anticipate working for long hours or performing the repetitive motion, take a break if you feel tired and perform quick stretches when possible.
- Invest in good gear. If you plan on exercising regularly or getting involved in sports, invest in good sports gear and shoes. Worn-out and poorly made equipment do not provide the stability and support that your ankle needs.
- Read about Best Brace for Sprained Ankle.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.