Wimbledon Reminds Us How To Treat a Sprained Ankle

With Wimbledon fever well under way and a particularly injury prone year among the top seeded players I thought it might be interesting to have a look at the most common tennis relates sports injuries. Research has shown that there are 54 injuries per 1000 games played (Pluim et al 2006). Among the most common injuries are a sprained ankle, shoulder strain, calf strain, tennis elbow and back injuries. 

Let’s take a closer look at the sprained ankle.

The sprained ankle is highly common in both the elite and the recreational sportsperson. The sudden sprinting, side movements and change of direction as required in tennis can cause the ankle to twist, particularly if the player is becoming fatigued or are playing on a slippery surface. The likes of Andy Murray and Roger Federer will wear ankle braces during matches in order to reduce the risk of such injuries.

An ankle sprain can be defined based on the degree of ligamentous injury. A grade I sprain involves mild damage to a ligament or ligaments without instability or effect on the normal range of movement of the joint. A grade II sprain is considered a partial tear to the ligament, involving a considerable portion of the fibres showing increasing laxity however with a definite end point. A grade III sprain is a complete tear of a ligament, causing instability in the affected joint and some bruising may occur around the ankle (Bruckner & Khan 2009).

The lateral structures of the ankle are most commonly affected with the main mechanism of injury involving over inversion of the ankle (rolling over on the ankle). The anterior talo-fibular ligament is mostly affected. Depending on the degree and severity of the injury there may be other soft tissue involvement.

Identifying the symptoms associated with a sprained ankle is important in ruling out any likelihood of a break. When a sprain occurs blood vessels will leak into the tissue surrounding the ankle joint. In response to this, white blood cells responsible for inflammation, will pool to the area and there will be increased blood flow. This results in swelling and pain. The nerves in the area will become more sensitised due to this swelling causing a throbbing like pain that increases as weight is put through the ankle. This will lead to reduced range of movement of the ankle joint and associated pain (American Academy of Orthopaedics Surgeons).

Treatment

Once the ankle sprain has been identified it is important to treat it appropriately. The RICE principles should be applied immediately after injury. This involves Rice, Ice, Compression and Elevation. This will help to reduce blood flow to the ankle joint thereby decreasing swelling and associated pain (Jarvinen et al 2007).

Early mobilisation of the joint should be encouraged after an initial rest period. There are conflicting opinions as to the appropriate time to begin to mobilise the joint following injury. It has been shown that early mobilisation can lead to the formation of a larger connective tissue scar. On the other hand prolonged immobilisation can lead to slower return of range of movement and a prolonged rehabilitative process. The general consensus is to wait 48hours before initiation of mobilisation to allow swelling and pain to decrease (Bruckner & Khan 2009).

Following the initial acute period it is important to begin the appropriate rehabilitative process to ensure complete recovery before returning to sport. A recent study by Beakley et al (2010) found that the initiation of a supervised rehabilitative programme in the first week after an ankle sprain has the best functional outcome. A rehabilitative programme, designed to increase the strength, stability and flexibility of the ankle joint and prescribed and supervised by a chartered physiotherapist is encouraged in order to achieve a speedy return to sport and prevent reoccurrence of injury.

By Paula Morgan.