The most common injury – Ankle Sprains

There are many risk factors that cause injury within performance and activities. Fitness and training are very important and appropriate training should be used. This may include; endurance training, anaerobic training, speed, strength, co-ordination, flexibility, specific skills and cross training. Without appropriate conditioning, muscles, tendons, ligaments and bones are more likely to suffer injury. To be effective the programme would have to be long term, reducing the risk of injury and prepare for peak performance, achieving set goals and targets whilst also maintaining technique and skill.

A lack of warming up and stretching is another major cause of ankle injuries. Also to prevent injury the venue the activity/sport is held at must be tidy and clean, there are to be no uneven surfaces and objects causing obstruction to be removed or padded. The equipment should be specially designed for the activity, safe and have correct maintenance. There is also a video analysis which can be used to identify any weaknesses to your running or walking techniques. Unfortunately for us, females are 25% more likely to sustain ankle injuries than males.

Tendons connect muscle to bone; a strong group of fibrous connective tissue and made from collagen closely packed together. Tendons can be stretched and torn under large amounts of stress but is able to resist strain. Ligaments connect bone to bone. Injuries that occur in ligaments are called sprains; this is through stretching and tearing. There are many bones in the ankle to connect each other to, however, because the Lateral Ligament is the weakest in the ankle sprain injuries are most common.

When Ligament damage occurs then you also must be aware of any damage to the tendons around the location of injury, through bone and joint tissue. Small fractures and ankle joint dislocation arise because of this, furthermore with bad strains causing ruptures. A lot of rest is needed in order to aid recovery time, as it can vary in different cases. If all other factors are positive then the injury should take four to six weeks to heal.

There are different responses to healing process; acute injuries take 48-72 hours to heal and recover, Sub-acute injuries take 48 hour plus to heal and recover, Scaring and repair will usually take six to eight weeks and remodelling take from three weeks up to a year.

There are treatments for immediate sprained ankle injuries. A well known treatment is usually referred to as RICE, (Rest, Ice, Compression and Elevation). The injured athlete must rest as this reduces pain and any further damage that may well occur. Ice is often used as ‘Cold Therapy’ and also with compression as they ease also pain, swelling and bleeding, if any and later aids blood flow. Elevation of the sprained ankle reduces bleeding and swelling as fluids flow away from the location.

Other longer term actions that would be used in a rehabilitation plan would be to help with the range of motion of the ankle, starting by gentle circles of the injured site, using light exercises on an exercise bike or a cross trainer. Only gentle and limited exercises are to be used as the ligaments in the ankle are still undergoing healing process. Stretching techniques are required of the gastrocnemius (top of calf muscle), soleus (bottom calf muscle) and Achilles tendon (attaches calf to heel) as these muscles and tendons are likely to become tight and inflexible. Additional practises used could be ankle weights to help strengthen ligaments and muscles. Standing on your toes without aggressive pain allows you to identify if the ankle injury is starting to heal. Another use of rehabilitation is Pool Therapy; deep water running, progressing to half speed running and running in straight lines, no dodging or circling as this is a risk factor too soon after injury.

Exercises for ankle sprains (also maintain fitness)

Cold therapy- Ankle to be wrapped in elastic bandage covered with ice pack; elevate the ankle above the heart to help fluid flow away from injured site, 20 minutes 3 times a day.

Stretching of Achilles tendon (non weight-bearing)- Use a towel to pull foot toward face, 15-30 seconds, 5 repetitions, 3-5 times a day.

Stretching of Achilles tendon (weight-bearing)- Stand with heals on the floor and bend knees, 15-30 seconds, 5 repetitions, 3-5 times a day.

Alphabet- Move the ankle drawing letters of the alphabet or drawing out your name, 4-5 times per day.

Isometric exercises- Resist against an immovable object or contra-lateral foot, Hold for 5 seconds, 10 repetitions, 3 times a day.

Toe curls and pickups- Place foot on towel and curl toes, pull the towel towards the body. Pick up marbles or small objects using toes, 2 sets of 10 repetitions, 2 times a day.

Toe raises and heel walks- Lifting body rising up on heals or toes, walking forward and back, 3 sets of 10 repetitions, 2 times a day.

Wobble board- Place both feet progressing to two, balance on board rotating in circular motion5-10 repetitions, 2 times a day.

Surface Walking- Normal heel-toe walking action, progress from hard, flat surfaces to uneven various surfaces, 50 feet, 2 times a day.