A sprained ankle is the most common sporting injury, particularly in pivoting & jumping / landing sports. It is particularly common in the sports of basketball, netball, field hockey, and football codes. In hockey, while there is evidence that the incidence has decreased since the introduction of artificial turf, it is still reported to account for between 4% & 27% of all hockey injuries.
There is no such thing as a simple ankle sprain, as 50% to 65% are associated with prolonged recovery and associated injuries such as fractures, cartilage damage & other joint injuries. There are several possible complications to consider when the injury is severe or healing more slowly than expected. However the 'uncomplicated' ankle sprain basically involves tearing to the lateral ligament complex of the ankle - the ligaments on the outside of the joint. The most common cause is the ankle rolling in while the foot is pointing downwards, usually when landing from a jump or stepping awkwardly. This is known as an inversion injury. The main ligament affected is the anterior talofibular ligament (see diagram). The calcaneofibular ligament is usually affected to a lesser degree, & the posterior talofibular ligament is less commonly involved. The tibiofibular ligaments (pictured) are rarely injured with an inversion sprain, and are more vulnerable in contact sports. This is known as a syndesmosis injury, and is one of several differential diagnoses to consider when examining an ankle injury.
In most cases there will be swelling, & this may be immediate & severe. Bruising may arise over the next few days, & will sometimes extend down into the toes. An XRay is often recommended, but may not be necessary. An experienced sports practitioner can advise you regarding this, and how to manage the injury. This will include 'RICE' treatment (see under 'Acute Injuries'). This will be followed by progressive stretching, mobilisation and exercise.
Treatment:
Treatment for ankle sprain will consist of techniques to reduce swelling & inflammation, and to restore normal range of motion.
Restricted movement is one of the factors likely to delay recovery. In particular the inability to bend the ankle fully makes running difficult, and can aggravate the injury further. Up to 10% of sprains which are normal on initial XRay, in fact have an underlying fracture which can complicate recovery. Regardless of this, sprains are frequently associated with severe soft-tissue injury and prolonged swelling & inflammation. Long-term instability is common, and the chances of re-spraining the ankle are high, particularly during the first year. Research in hockey shows that ankle sprains are one of the injuries most likely to be associated with prolonged time on the sideline. For this reason it is important to strengthen the ankle once recovery is underway. It is also recommended to apply rigid strapping or a brace for return to sport. This will help to prevent a recurrence of the injury.
References:
1. Dick, R. et al (2007). Descriptive epidemiology of collegiate women’s field hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002- 2003. Journal of Athletic Training, 42, 2, 211- 220.
2. Murtaugh, K (2009) Field Hockey. In Caine D et al (eds) Epidemiology of Injury in Olympic Sports Vol XVI. Chapter 11.
3. Murtaugh, K (2001) Injury patterns among female field hockey players. Medicine & Science in Sports & Exercise, 33, 201-207.
4. Sherker, S & Cassell, E (2002) A review of field hockey injuries & countermeasures for prevention. Monash University Accident Research Centre Report.
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