Ankle Sprains

There may be no more common an injury in ball sports than the sprained ankle. Conversely, there is no part of the competitive human body that is afforded less respect in both its immediate care and return to sport than the injured ankle. An effective and pain-free return to competition from the misunderstood and often minimized ankle sprain requires a thorough understanding of its mechanics.

In any activity where a premium is placed upon advancing an object toward an opponent's goal, using speed and power, the ankle is the joint that bears a relentless strain. Ankle sprains occur because the ankle joint, through either sudden forces being applied to it or through the misadventure of an athlete landing on an opponent's foot, is forced to move in a direction beyond what it is constructed to do.

The most common cause of an ankle sprain due to motion is when an athlete seeks to change direction at speed, and the ankle sustains an inversion, whereby the ankle joint moves inward as the player travels outward. The "plant" foot is placed in the opposite of the intended direction of travel. As force is applied to shift from the plant foot to the changed direction, or "cut," the anterior talofibular ligament (one of the three ankle ligament groupings) is the most frequent recipient of the excessive stress that causes the sprain.

Eversion, the movement of the ankle outwards from its natural plane, is caused where the ankle joint is subjected to outward forces with the foot remaining fixed to the surface.

A syndesmosis, or high ankle sprain, is a more serious type of injury. This situation can occur when the foot is planted and the lower leg is rotated, causing the talus (ankle bone) to wedge itself further between the tibia (shin bone) and fibula (outer lower leg bone), straining the ligament structure that connects these bones. This type of condition will usually be a more disabling sprain for the athlete, and requires a correspondingly longer recovery time and more intensive rehabilitation.

The severity of an ankle sprain will depend upon a number of factors, including the severity of the movement causing the sprain, how quickly the athlete receives medical attention, and whether the athlete has a history of sprains. There are three categories of sprains. A Grade 1 sprain is a microscopic tearing of the fibers in one of the three sets of ankle ligament. This type of sprain will likely prohibit the athlete from continuing with the activity that day; there will be a mild level of discomfort, and a corresponding degree of swelling, either at the time of the injury or in the following one or two hours. In a Grade 2 sprain, noticeable swelling will be observed in the vicinity of the joint. There is a complete tear of some of the ligament fibers. The athlete will have difficulty moving without assistance; some instability in the ankle joint will likely be observed as well. In a Grade 3 sprain, the ankle joint will be noticeably unstable and the athlete will be unable to bear weight on the ankle without assistance. The ligament will be completely torn or ruptured, with significant swelling and pain.

Ankle sprain first aid is simple, but it is a discipline that requires thorough attention to all steps of the process. For a Grade 1 sprain, the treatment progression is known by the acronym PRICE: Protection of the injured joint, by way of compression bandages and similar devices; Rest, by not walking on it to permit the sprain to recover; Ice, to be applied at regular intervals to reduce swelling; Compression, pressure applied in conjunction with ice; and Elevation, with the injured joint elevated above the level of the heart for the first 48 to 72 hours after the injury whenever possible, to prevent the pooling of blood at the point of the injury.

For the treatment of a Grade 2 sprain, the same PRICE principles apply; in addition, depending on the circumstances of the athlete, the ankle may be immobilized for a period of one to two weeks. When a Grade 3 sprain is diagnosed, a physician will be required to assess the surgical option or whether a cast should be applied, likely for two or three weeks.

Most athletes who encounter longer term problems with a sprain are those who either come back to competition too quickly after a sprain, or those who fail to follow a proper program of rehabilitative exercises. They must also take into consideration the overriding principle that any return from any injury must be carried out progressively, with a gradual increase in workload and intensity. Exercises should include a thorough warm-up, which requires both an elevation of heart rate and resultant blood flow to all muscle structures. The athlete should be careful to work out on even surfaces. They should also ensure that their athletic shoes are in good condition. Finally, they should include stretches of the Achilles tendon, foot flexors, and calf muscles, as well as ankle rotation exercises.

see also Achilles tendonitis; Ankle anatomy and physiology; Athletic shoes; Sprains and strains.