Sprained Ankle ... again

A minor (grade 1) ankle sprain is a common injury seen by sports and remedial massage therapists. Most often a sprained ankle occurs through rolling onto the outside of the foot and overstretching the ligaments around the ankle. This may happen coming awkwardly off a step or pavement, or perhaps during a sociable night out! In athletes, ankle sprain has been found to be the most common injury sustained, especially in high-speed, multi-directional sports like squash and football (Fong et al., 2007).

It can be a frustrating injury; up to 40 – 50% of minor sprains can lead to ongoing weakness and repeat sprains, and a condition known as chronic ankle instability (Doherty et al., 2014). The good news is that minor sprains mostly have a good prognosis and respond well to early massage therapy. There is no joint instability and the weakness is most often actually due to a loss of ‘proprioceptive’ sensory feedback. Your sports massage therapist has specific skills to help get you back to action quickly and avoid further pain and time away from your sport. If your sprained ankle is more serious, you will usually be referred to a physiotherapist for joint care.

Your sports massage therapist will first assess your whole body biomechanics. Any imbalances between supporting muscles and tendons can impair ankle range of motion and predispose to lower limb injuries (Brukner and Khan, 2009). Postural imbalances of the foot and high arches may predispose to ankle injuries, because of more weight-bearing through the lateral foot. Normal ‘pronation’ of the foot is vital for shock absorption, so if this cannot occur normally the ankle may be more unstable, putting strain on the ligaments (Brukner and Khan, 2009). Your therapist will use advanced techniques to lengthen short muscles and strengthen weak muscles to help improve any imbalances. Certain risk factors have been found to contribute to ankle injury risk and your therapist may advise you how to modify these; for example your training, neuromuscular control, balance and muscle strength. Kinesio taping may also be an effective adjunct to massage to support proprioception and speed healing.

If you've still got symptoms from an old sprained ankle, what can you do?

Book an appointment with a massage therapist who will work to help break up scar tissue that may have formed in the ligaments as a result of your sprained ankle. You can introduce regular stretching at home to lengthen tight muscles. Static stretching is the safest self-treatment method to increase flexibility, and gentle daily stretching for just 30 – 60 seconds is adequate (Brukner and Khan, 2009). Some helpful stretches include calf stretches (with both bent and straight knee), achilles stretches, drawing the alphabet with your toes to improve ankle mobility, and rolling your foot on a golf ball to release tight foot muscles. Static stretching is not advised before sporting activity, but a foam roller is an alternative to warm up the calf muscles before activity and may improve ankle range of motion (Halperin et al. 2014).

If your sprained ankle was a recent injury, you may need to focus on non-weight bearing activities for a couple of weeks, such as cycling, swimming, and pool walking/running to maintain your fitness while the ligament heals.

Functional exercises are important to restore strength and flexibility. Strong evidence has shown that, when incorporated with balance and proprioception exercises, these type of exercises may speed recovery and reduce re-injury (Kaminski et al., 2013). Balance exercises can be started as soon as your pain allows and both limbs should be exercised equally (Wikstrom et al., 2009). This form of balance training for 3 – 12 months may reduce the risk of further sprains in athletes by up to 60% (McKeon and Hertel, 2008). For anyone with a sprained ankle and weakness, a simple one-foot-balance exercise can be done daily for 30 seconds, while brushing your teeth to make it easier to remember! Ideally ask for help from a qualified therapist to progress these exercises, particularly if you have a history of ankle sprains.

In conclusion, a sprained ankle is a common injury which can potentially become very frustrating, but can be managed successfully with a clear exercise program and massage therapy.

References:

Fong et al., 2007
Doherty et al., 2014
Brukner and Khan, 2009
Halperin et al. 2014
Kaminski et al., 2013
Wikstrom et al., 2009