The ankle is the most commonly injured joint in the body. Most people will roll over on their ankle and this causes injury to the lateral ligaments located on the outside of the ankle joint. There are 3 lateral ligaments (see diagram below) that can be injured and the severity of the injury dictates how many of these ligaments are injured.
Ligaments and Injuries
A ligament is designed to protect your joint from moving too far in any one direction. It is made up of lots of thin fibres (like ropes) that are all lined up parallel and go from one bone to another across a joint.
There are different amounts of injury you can do to a ligament. Any injury involves the tearing of fibres within the ligament. In a very minor injury only a few fibres are torn and will quickly and easily repair. You may not even be aware of this type of damage. As the severity of an injury increases more and more fibres within the ligament are torn. The worst type of injury involves the tearing of all the fibres and this may require surgery to repair.
As you can see from the diagram there are 3 lateral ligaments in the ankle. They are labelled in this diagram the anterior ligament, middle ligament and posterior ligament for simplicity (they have long Latin names in reality but why confuse the issue).
When you injure your ankle in most cases you will injure the anterior ligament first. There will be some tearing of its fibres and in a minor sprain this is the only ligament that will be injured. If the injury is a bit worse then both the Anterior and middle ligaments will be injured and in the worst type of injury all 3 ligaments will be involved. When all 3 ligaments are involved there is a good chance the anterior ligament will be completely torn.
When you initially injure your ankle (or any joint) the initial things you do can make a big difference. The old R.I.C.E regime is very effective.
- R Rest - Try to rest the ankle as much as you can. In severe injuries this may involve the use of crutches to help with moving about.
- I Ice - Will help to reduce swelling, decrease bruising and start healing. It should be applied for 20 minutes at a time intermittently over the first 24-48 hours or for as long as the ankle gives off heat.
- C Compression - A bandage or some tubigrip will help to reduce the swelling and control bleeding within the injured area.
- E Elevation - Keeping the foot up (preferably above heart height) helps to increase the return of swelling to the normal blood flow system.
The use of all these techniques can help to reduce the amount of time you are in pain, reduce your swelling, reduce the bruising, reduce inflammation and speed up healing in an ankle injury.
Your physiotherapist can use a variety of techniques to help speed the healing of your ankle injury. These include:
- Interferential and ultrasound to reduce swelling, decrease pain, reduce inflammation and speed up healing
- Massage to reduce swelling and speed up healing
- Joint mobilisations to loosen up the joints and stretch tight ligaments
- Taping to help support the joint while the ligaments heal
- Exercises to strengthen and stretch the muscles and ligaments and retrain your balance
Proprioception and The Ankle
Proprioception is the body’s ability to know where a body part is in space. You can touch your nose with your eyes closed because your brain knows where your arm and nose are in space pretty accurately. The same applies for the ankle and when we walk this ability is used all the time to stop us from tripping or falling over. When you injure your ankle this ability is affected and needs to be retrained. This is why your physiotherapist will give you balance exercises to do at home and get you on the wobble board while getting treatment.
Not all ankle injuries are just sprains of the lateral ligaments. If you even suspect you have a fracture/break get an x-ray. If pain persists and despite treatment you may need further scanning via an MRI, CT or bonescan.