A strain is the over-stretching or tearing of a muscle or tendon. A sprain is the same in the ligaments. The most common ligament sprain we see? The ankle.
Sprains can occur in multiple places but most commonly on the outside of the ankle (the lateral ligaments). How do you know if that’s what you have?
- Usually located on the lateral malleolus (the boney bit on the outside of the lower leg) or just inferior to. Be aware though that commonly the most discomfort is reported to be on the inside. This occurs as the medial bones “kiss” when the ankle is rolled (or inverted). Patients often complain this is the pain that stops them as rehab continues, not so much the lateral pain.
- This can be quite substantial and at times frightening for patients. The area has a great blood supply, and damage occurs to the blood vessels. The effusion can be immense and gravity can contribute.
- Reduced movement. A restriction in the range of movement can be due to either the pain or the instability, or sometimes the volume of swelling.
What do we worry about?
- Can you weight bear? It is an important question your physio will ask. It is diagnostic of more sinister pathology. Less ability to weight bear? More likely there is a fracture.
- Is there a pulse? Physios will feel for temperature differences between left and right, they may feel for your dorsal foot pulse. This is to ensure the vascular damage is only minor.
- Re-occurrence. Is this the first episode of pain? If not, how often is it occurring? Repetitive ankle sprains are a sign of improper rehabilitation and or structural laxity in the ligaments. The concern is that a hypermobile joint may have less integrity and more bone impact.
What to do?
Start acute injury management. RICER. Rest, Ice, Compression, Elevation, Referral.
Avoid prolonged weight bearing, use crutches if need be and apply ice for 10mins on/off for 48 hours. An ice bath is even better than the old frozen peas. Put a couple of handfuls of ice cubes and a cup of water into a bucket, immerse your ankle for as long as you can stand (5 minutes or so). Some suggest wearing a sock/plastic bag to protect your toes from feeling too cold. Wrap a compression bandage from the end of your toes to half way up your calf muscle. Put your feet up, higher than your heart to assist gravity in reducing swelling.
Call your physio! Research shows the sooner your rehabilitation begins, the better your outcomes.
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