Ankle Injury Assessment
Sprains are graded on a scale of 1 to 3 (mild, moderate, and severe), depending on the degree of tearing to the ligaments. In most cases, x-rays are performed to rule out a fracture or dislocation.
Grade and Description
- Minor tear
- Minimal pain
- Little or no joint instability
- Mild pain with weight bearing activities
- Slight loss of balance
- Some tearing of the ligament fibres
- Moderate to severe pain
- Moderate instability of the joint
- Swelling and stiffness
- Pain with weight bearing activities
- Poor balance
- Complete tear of the ligament
- Severe pain followed by minimal pain
- Gross instability of the joint
- Severe swelling
- Possible pain with weight bearing
- Poor balance
The immediate treatment of any soft tissue injury consists of the RICER protocol – rest, ice, compression, elevation and referral. RICE protocol should be followed for 48–72 hours. The aim is to reduce the bleeding and damage within the joint. The ankle should be rested in an elevated position with an ice pack applied for 20 minutes every two hours (never apply ice directly to the skin). A correctly sized compression bandage should be applied to limit bleeding and swelling in the joint.
The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.
A sports medicine professional should be seen as soon as possible after the injury to determine the extent of injury and to advise on treatment and rehabilitation. In evaluating the injury the sports medicine professional may order an x-ray or other testing to determine the extent of the injury.
Rehabilitation and return to play
Most ankle sprains heal within 2 to 6 weeks, however severe sprains many take as long as 12 weeks.
A comprehensive rehabilitation program minimises the chance of the injury recurring and includes flexibility, balance, stretching, strengthening and sport specific exercises. During this time, taping or bracing the ankle may be prescribed to provide support until full function is regained. If, while performing a rehabilitation exercise, ankle joint pain or discomfort is experienced, stop immediately and reconsult a sports medicine professional.
Players with significant ligament injuries (Grade 2 or 3) are advised to use bracing or protective taping when playing sport for a minimum of 6 to 12 months post injury.