What is an ankle sprain?
A sprain is a stretching or tearing of the ligaments that connect the ankle bones. Ligaments on the outside of the ankle are frequently injured when the foot is turned inward or “rolled over.”
What are the signs and symptoms of an ankle sprain?
Pain, swelling, and inability to walk or run are common complaints. Usually the bone is not as tender or sore as the area around it.
How can I rehabilitate an ankle sprain?
Completing a functionally progressive rehabilitation program (walking/jogging/running) speeds return to usual activities and may prevent recurrent injuries or problems. Fitness should be maintained by doing alternative pain-free activities (eg, swimming, weights, cycling) during the rehabilitation process. Participating in sports before normal motion and strength have returned can result in further injury or permanent disability. Physical therapists or athletic trainers may be very helpful. If this is the case, your pediatrician will make a referral. Rehabilitation consists of three phases. It may take as little as two weeks to complete for minor sprains or up to eight weeks for severe sprains. If the injury is not improving with the rehabilitation program, a return visit to your pediatrician or referral to an orthopedist or sports medicine specialist may be necessary.
Phase 1: Resting and protecting the ankle to permit healing, prevent further injury, and control pain and swelling (usually two to three days).
Initial care involves PRICE (protection, rest, ice, compression, and elevation). Use of elastic bandages, braces (figure 8, stirrup), casts, and crutches depends on the severity of the injury. If a bone is not broken, putting weight on the ankle is permitted and encouraged, sometimes even on the day of the injury. Ice (15 to 20 minutes every few hours for two to three days), compression (pressure wrap), and elevation (above the heart) help control swelling and pain. Anti-inflammatory drugs, such as ibuprofen or naproxen sodium, help reduce pain and swelling but may not promote healing. Heat should never be used in the initial treatment period. Several easy exercises can help improve ankle range of motion. Your pediatrician will tell you when to begin these exercises, how often to perform them, and for how long to continue. A beginning exercise (three times a day) is to write the alphabet in the air with your toes. Make the letters bigger as your motion improves.
Phase 2: Starts once pain and swelling begin to subside and athlete can comfortably bear weight and walk. Apply ice to ankle after each rehabilitation session.
Begin strengthening and range of motion exercises as soon as enough ankle movement has returned to do the exercises properly. Simple toe raises on a flat surface or on the edge of a step, held for 10 seconds and done 10 to 12 times each session two times a day, are easy exercises to start with. Pushing down, pulling up, and turning in and out against elastic tubing or a towel wrapped around the foot and held by the athlete or a partner can also help restore strength and motion. Hold each movement for 10 seconds, 10 to 12 times each exercise session. Complete one or two exercise sessions each day. Your pediatrician will show you how this is done.
Phase 3: Restoring ankle function and sport-specific skills. Apply ice to ankle after each rehabilitation session.
This phase begins after joint motion has been regained and strength and low-impact aerobic activities are tolerated (walking/jogging). Balance can be restored by standing on the injured leg for up to 30 seconds with or without hands held out to the sides and with or without eyes closed. Early on, holding a tabletop may be necessary to be stable. As balance improves, agility exercises, including jumping forward, backward, and side to side, can be added. Functional progression continues with jogging and then running straight on a flat surface. This progresses to “cutting” (running figure eights) and then sprinting. Sport-specific drills should be added with a gradual return to practice and competition. Rehabilitation exercises, taping, and/or bracing should be continued until the athlete is symptom free with full activities for at least one month.