Ankle Sprains

Ankle Sprains

Ankle sprains are one of the most common sporting injuries – and are most prevalent in sports such as basketball and netball. However they are becomming more and more common with an increase in recreational running - particularly on uneven ground.

As a quick background:

• Ankle sprains accout for an estimated 1-1.5million A&E visits per year.1
• You are much more likely to injure the lateral aspect (outside) of your ankle, than the medial (inside). 
• Once sprained, you have over a 50% chance of re-injuring that ankle (reduced through effective rehabilitation).2
• A sprain involves to damage to ligaments that support our joints.
• A strain involves the stretching or tearing of muscle fibres.

The most common form of ankle sprain is an inversion injury, which involves the ankle 'rolling' outwards while the foot is planted, stressing the ligaments supporting the lateral aspect (outside) of the ankle joint. These ligaments (particularly the Anterior talofibular, and calcaneofibular ligaments) are put under excessive force, stretching them beyond their physiological limits and causing microtears within the fibres.

Sprains can be classified into 3 types:

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• First degree - partial tear of ligament
• Second degree - incomplete tear with moderate functional impairment
• Third degree - complete tear and loss of integrity of ligament

In a majority of cases, not only are the ligaments affected, but also the muscles and nerves running over the joint, and sometimes the joint surfaces themselves. It is important then, to be able to recognise symptoms of an ankle sprain, and how they relate to the structures within your ankle. The most common symptoms are:

• Immediate inflammation (swelling, redness and increased temperature) around the entire ankle joint - An influx of inflammatory exudates and oedema from the blood is your body's natural defence system.
• Inability to weight bear.
• Pain - nerves become much more sensitive, especially to the chemicals that your body floods to the injury site.
• Loss of movement and strength (associated with inflammation, and inhibition of skeletal muscle).
• Bruising along the bottom of your foot, both inside and out (particularly with more severe sprains - Grade II +). A decrease in skeletal muscle pump combined with ruptured blood vessels means blood pools at the bottom of the foot due to gravity. 
• Joint stiffness - possibly from synovial thickening around joints and the lack of movement within them. 

Immediate treatment..

The duration of your injury and type of rehabilitation you undergo will depend a lot upon the seriousness of the sprain. However serious the sprain is, a large proportion of the treatments remain the same, it is only the duration of each that will change. Immediate treatment (0-72 hours) should primarily be P.R.I.C.E (protect, rest, ice, compress and elevate), combined with Non-Steroidal Anit-Inflammatory Drugs if tollerated or administered by your GP.

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Getting the strength back...

As the healing process progresses, and inflammation is controlled, gentle exercises (strengthening and stretching) should be commenced to maintain functional movment and prevent joint stiffness. This can often be done with static stretching and a piece of resistance band. Particularly in the case of Grade III sprains, immobilisation is recommended for the initial four days post injury, again, accompanied by gentle exercise.

Sport specific...

Once you are able to fully weighbear, and have good range of movement and strength around the ankle, specific exercises are neccesary prior to any return to sport / activity. The aim of rehabilitation should now be to improve neuromuscular function3. In simple terms, this means balance training to increase the rate at which your body activates lower leg muscles in response to an uneven surface - and prevent injury. Activities in this final stage need to be functional, and should look to include single leg squats and bounds etc, with the focus on explosive movements on and off uneven surfaces.

Follow the link below for an example of a PhysioFitness exercise programme that may be used alongside other treatments to rehab an ankle sprain....

http://www.dmphysiofitness.co.uk/login/?remove_header=y&first=712454&username=tagalisw&password=abegsvxy

Hints and Tips For Ankles

• Use good fitting / well done-up footwear, particularly when on uneven ground.
• If you have previous ankle injuries, you are statistically more at risk of further injury.
• However, immediate treatment will ensure faster return to full function and reduce joint stifness.
• Balance is key, everything starts at your ankle.
• Be pro-active, spending time on prehab is better than spending money on rehab!

1. NHS., 2010  http://www.nhs.uk/conditions/sprains/pages/introduction.aspx
2. Yeung, M. S., et al., 1994. An epidemiological study on ankle sprains. Br J Sp Med; 28(2)
3. Hertel, J., 2000. Functional Instability Following Lateral Ankle Sprain. Sports Med; 29: 5(1): 361-371(11)

Written by Declan Foley

Knee Osteoarthritis - What can we do?!

‘Wear and tear’ is a common expression bounced around now-a-days to describe gradual arthritic changes in joints (particularly knees), which many of us may one day be faced with. Recent figures show that more than 8 million people in the UK are affected by Osteoarthritis (OA)¹, which can result in pain, decreased mobility and giving way.

Wear and tear is in fact the thinning of cartilage and formation of bony spurs at the edges of the joint, which can rub and limit movement.

A common misconception is that this pain will increase, and your only option is to stop activity all together. Pain medication and anti-inflammatories can temporarily reduce symptoms, however are not a long term fix, and are not tolerated by everyone.

A more effective option can be Physiotherapy, which combined with regular exercise has been shown to be a cost-effective alternative treatment, providing large reductions in pain and stiffness^{2, 3}. Physiotherapy can also decrease the need for a total knee replacement through the use of specific exercises – improving the quality of leg musculature which can often be reduced in OA, even though you may be pain-free⁴.

In general, regular exercise with an effective warm-up and cool-down is important in keeping joints healthy and muscles supple. With the 2012 Olympics approaching, is this a perfect time to get active and look after you future?!

1. Arthritis Research UK, 2012.
2. Deyle et al., 2005. Phys Ther;85:1301–1317
3. Deyle et al., 2000. Ann Intern Med; 132:173–181
4. Conroy et al., 2012. Arthritis Care Res;64(1): 15-12

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