Ankle Sprains

A common injury in racquetball as well as in many sports is the sprained ankle. You're chasing down a cross-court pass in the third game tiebreaker...you're tired and you're trying to concentrated on the ball...your mind says execution but your body says I'm tired and what often happens is your leg doesn't quite make the next step, your shoe catches on the floor and your body drags over your ankle. The best thing to do in this situation is roll with your fall...but too often you'll try to stop your momentum using a "turned ankle" and subject it to excessive weight and stretch...resulting in a soft-tissue injury or sprain.

What is a sprain?

A sprain is an injury to a joint that results in the stretching or tearing of ligaments and possibly the joint capsule and tendons.

Ligaments are sheets or bundles of fibers that form a connection between 2 bones. They help strengthen the joint to reduce injury. When the ligament is forced beyond its anatomical limit then injury occurs.

Causes of Ankle Sprains

Inversion sprains - this happens when the sole of the foot is directed toward the body and the foot is extended.

Eversion sprains - this happens when the sole of the foot is directed away from the body and the foot is flexed.

Syndesmotic sprain - this can happen when there is a severe inversion or eversion sprain. These severe sprains usually have an extreme rotation component causing a tear or rupture of the ligaments.

Most Commonly Affected Ligaments

Outside or lateral side of the foot

These are called inversion sprains. This is the most common place for an ankle sprain. The ligaments affected are the anterior talofibular, calcaneofibular and posterior talofibular.

 

Inside of medial side of foot

These are called eversion sprains. They represent only 5-10% of all ankle sprains. The ligaments affected are the anterior tibiotalar, tibionavicular, tibiocalcaneal, and posterior tibiotalar.

 

Upper Ankle

These are called syndesmotic sprains. This injury usually happens in conjunction with a severe inversion and/or eversion sprain. The ligaments affected are the anterior tibiofibular and posterior tibiofibular.

Sports and Sprains

Sports that have a lot of side to side movement and jumping are prone to causing ankle sprains (racquetball, basketball, tennis, rugby, volleyball, soccer, etc).

Immediate Care of Ankle Sprains

When an ankle sprain occurs, the ligaments and tissues are torn causing blood to flow out from the broken blood vessels and fill the spaces between the cells. This causes the swelling and discoloration that is commonly seen. Swelling is the biggest cause of pain and discomfort.

 

R.I.C.E. (Rest - Ice - Compression - Elevation)

All of these reduce swelling and ultimately help recovery.

Rest reduces the body's blood flow and reduces the amount of blood loss from theh broken blood vessels. This means remain off your ankle as much as possible and definitely do not return to strenuous activity for a minimum of a week, depending on how severe the sprain is. If activity is started too soon, you can end up with an even worse sprain or ankle discoloration. This is because the ligaments are not healed enough. Ligaments do not have a good blood supply and the healing time is therefore longer than you might expect. Even when you can walk on your ankle without pain, it may still not be completely healed. Refer to a trained physician to know when you can start activity again.

Ice constricts the blood vessels and reduces the blood flow to the injured area. Ice should be applied as soon as possible after the injury.

Crushed ice is best because it forms nicely to the ankle. If a reuseable freezer pack is available then be sure to use a towel between the skin and the pack. Reuseable packs keep cool much longer than ice and can result in frostbite. Ice should be applied directly over the swelling and painful area. You should "ice" the site for 15-2- minutes and repeat this every hour.

Compression keeps the blood from expanding into the skin and forces it back into the bloodstream. Use a 4-ince Ace wrap. These can be bought at the local Walgreens or Walmart in the first aid department. The wrap should be snug but not too tight as to cut off circulation. It should be tighter around the foot and looser above the ankle. After you are done wrapping the injured ankle, squaeeze your big toe nail and then let go and see if the bed returns to pink quickly (1-2 secs). If the nail bed does not return to pink quickly then the wrap is too tight. Keep the wrap on during the day but never wear the compression wrap at night.

Elevation encourages the blood to flow back into the bloodstream. This is the most effective way of reducing swelling. Keeping the ankle elevated above the heart and preferably above 45° will help a lot. If you don't have ice or a compression wrap, then you can still elevate the leg. Elevation while you are sleeping will greatly reduce the amount of pain that you will have in the morning.

Prevention

Strength Training

Keeping the lower leg and ankle strongand flexible are very helpful in preventing ankle sprains. People who are at a desk all week and only play a few games over the weeken are at greater risk of injury than those who train 2-3 times a week.

Balance and Proprioreception

Having balance and proprioreception is essential to athletes. Proprioreception is the ability to determine where a joint is in space. This helps the brain know if the body is off-balance.Proprioreception is especially important to athletes who have had ankle injuries. When tissues tear the neurons also tear thereby decreasing the ability to know where the joint is in space. Therefore, it is essential that the athlete regains proprioreception by completing rehabilitation therapy. The lack of balancing ability can result in a greater risk for injury or reinjury. Balance and proprioreception can be increased by standing on one leg on a flat surface or wobbly surfaces such as balance boards or trampolines. All exercises can be made more difficult by closing your eyes.

Footwear

Proper footwear is very important when playing a sport that has a lot of side-to-side movement and jumping. The shoes for any particular sport are designed to decrease the forces placed on the ankle by that particular sport. Running shoes are made for straight-ahead activity and should not be used for activities such as racquetball which require side-to-side movements. If you have a history of ankle sprains, then try using high-top shoes. They offer a greater support than do low-cut shoes.

Ankle Braces

Lace-up supports and semirigid ankle braces have been found to help decrease the number of recurrent ankle sprains.

Effects of Repetative Sprains

Prevention and complete rehabilitation of ankle sprains are the best ways to reduce the number of ankle sprains you may receive. When a lot of ankle sprains are sustained, there is the possibility for chronic inflammation of the tendons resulting in tendonitis, degeneration of the ankle cartiage, and arthritis.

Disclaimer

This information should not take the place of a trained medical professional. Please consult an allied health professional (athletic trainer/physical therapist) or a physician to get the best course of action for your particular injury.