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Ankle Sprain

What Is An Ankle Sprain?

An ankle sprain is an injury that usually occurs at the outside of the ankle when you twist and/or land awkwardly on it. The tissues commonly injured in an ankle sprain are the ligaments. Ligaments are bands of connective tissue within the body that normally help to stabilise the joint by stopping unwanted movement. Following this injury, most people commonly experience pain, swelling, loss of function and sometimes an inability to fully weight bear.

There can be differing degrees of ankle sprain, therefore your recovery time depends on the degree of injury you sustain. Recovery can take anything from a few weeks to several months.

Ankle Anatomy

What Are The Symptoms Of An Ankle Sprain?

People can experience the following symptoms:

  • When you injure your ankle, you may hear a ‘popping’ sound or feel like your ankle has given way.
  • Pain, especially on weight bearing.
  • Swelling round the outside of the foot and ankle. This can be minor however some people experience a big amount of swelling.
  • You may experience bruising around the outside and/or inside of the ankle and this may spread into the foot and even down to the toes. This can worsen over a few days following the injury. If it doesn’t happen immediately it is not on its own a cause for concern.
  • When touching the painful area, you may experience some tenderness or pain.
Ankle Tear

How Common Are Ankle Sprains?

An ankle sprain is one of the most common lower limb musculoskeletal injuries experienced, especially in the physically active. Up to 70% of people will experience this in their lifetime.  Recurrence of this injury is very common, especially in the first year following the first injury.

What Causes An Ankle Sprain?

A sprained ankle happens when you roll over the outside of your foot and your foot turns inwards.  This normally occurs rapidly and you don’t get enough time to react. A sudden and rapid inward twisting force – or inversion injury is where the ligaments and muscles are over-stretched, sometimes torn or in rare cases ruptured. More rarely, your foot and ankle can move in the opposite direction over the inside of the foot resulting in strain to the stronger deltoid ligaments located on the inside of your foot. You can also develop ankle pain when your foot ankle flexes up the way rapidly or you twist your body round with your foot remaining planted on the ground.  

Common causes of an ankle sprain are:

  • Sudden change in direction/twisting movement
  • Impact during sport/recreational activity
  • Walking, running or exercising on uneven ground/terrain (for example walking across cobbles)
  • Twisting on a planted foot (for example studs getting caught on a football field)
  • Tripping or missing a step on the stairs – common in high heels.

Timescales / Prognosis

The pain from your ankle sprain should subside quickly, usually within 2 weeks. Only a small percentage of people may experience long-term pain after their injury.

There are differing severities of an ankle sprain. They can be categorised into mild/moderate/severe:

  • A mild ankle sprain can heal within a few weeks with self-management.
  • A moderate ankle sprain can take a few weeks to recover, however, you may be at risk of re-injuring your ankle within the first few months following injury.
  • A severe ankle sprain may take several months to recover, and some cases may require surgical intervention.

Ankle sprains have a high re-injury rate. You are at high risk for re-injuring your ankle in the first year following your sprain.

Most people return to normal function within 6-8 weeks and return to activity and sport within 8-12 weeks.

Pacing And Spacing

  • Pacing and spacing methods can help you manage your pain better.
  • Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks. Prioritising daily activities can also help. This can prevent “over stimulating” your pain system.
  • When completing challenging tasks or activities, it may be useful to set a “baseline”. This is the amount you can manage on a good or bad day without increasing your symptoms. Therefore you can plan rests and set achievable goals.

Pain Activity Ladder

  • By following the pain activity ladder you can identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.
  • The pain scale, most often used in healthcare, measures pain from 0-10 (zero being no pain and 10 representing the worst pain you could imagine).
  • If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.
  • When you are completing your rehabilitation exercises it is often best to work within the green (and sometimes amber zones depending on what you deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.

Exercises

Below are some exercises that you may find helpful in your recovery. Please start with the easier early stage exercises. As you begin to find the exercises easier you can then progress through to the middle and late-stage exercises.

 

When To Speak To A Health Professional

You should consider attending A&E or phoning 111 if you have any one of the following:

  • You are unable to fully weight bear and take 4 steps or more immediately after injury
  • If your foot is discoloured and this is not normal for you
  • If you experience altered sensation following injury which is lasting
  • Immediate bruising and/or gross swelling
  • Your ankle looks to be misshapen
  • If you have a known blood disorder

Help And Support

If after following the above advice, your symptoms have not improved within 6 to 12 weeks, a referral to a physiotherapist may be beneficial.

You can access physiotherapy by any of the following:

Additional information

Acute Injury Management

POLICE is an acronym (Protection, Optimal Loading, Ice, Compression and Elevation) that is used as a management strategy for many injuries and conditions for the first 24 to 72 hours.

  • Protection and relative rest are advised immediately after injury for the first 24 to 72 hours.
  • Optimal Loading refers to having a balanced rehabilitation program which encourages early and gradual activity to improve recovery. How you progress will vary from person to person depending on the injury. It is about finding the injured areas happy place and increasing slowly and gradually.
  • Ice may be used for reducing pain and swelling. There are safety points to follow when you use ice:
    • Don't ice over a numb area or open wound. If the skin is numb you won't notice if you're developing an ice burn and ice on an open wound can increase the risk of infection.
    • Be wary of ice burns – don't apply ice directly to the skin, wrap an ice pack in a clean, damp tea towel before applying. Avoid prolonged exposure to ice, 10-20 minutes is usually adequate.
    • Apply crushed ice/frozen peas wrapped in a damp towel for 10-20 minutes, 2-3 times per day for the first 5-7 days post injury/ flare up of pain.
    • Stop applying ice if there are any negative effects such as increase in pain or swelling or skin soreness.
  • Compression and Elevation are helpful for reducing inflammation. This can be done by keeping your joint raised on a pillow and compressed by wrapping a bandage around it.
    Do not make the bandage too tight and do not wear tubi-grip or any compression bandage in bed at night.
  • Heat: After 2-3 days, you may find that heat is more relaxing.

You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and is not directly touching your skin.

You should do this for 10 to 15 minutes, 3 to 4 times a day.

What do I do if my symptoms flare up?

Flare ups of pain are common. Some people have recurrent flare ups of pain so it is important to know how best to manage these flare ups. In most cases a pain flare-up will settle within 6 weeks.

Top Tips

  • You will likely find it helpful to rest a bit more but it is still important to keep active. This will help to avoid becoming stiff and your muscles becoming weak.
  • If you aim to get a balance between rest and activity it should help your pain to settle down. You may be sore at first, however, start slowly and gradually increase the amount you do.
  • Reduce movements or tasks that aggravate your symptoms. This can help especially in the early days.
  • Adopting positions or movements that reduce your pain can be useful.

Pain Relief

Analgesia

  • Analgesia also known as pain relief can be an important part in helping you manage your symptoms and allow you to stay active.
  • Taking suitable pain relief regularly allows you to move more normally and continue your usual activities without causing any damage. It is unlikely that medication alone will resolve your pain totally. For this reason we are using the term pain relief (A 30-50% reduction in pain would be deemed to be a good success).

Paracetamol

  • Paracetamol is a good general pain management medication. It is used to help manage lots of different types of pain.
  • Sometimes people believe they need something ‘stronger’ than paracetamol when in fact, taking a regular dose rather than a one-off dose is more effective.
  • Spreading the doses of the paracetamol evenly out over a day will help you control your pain. Visit NHS Inform for more detailed information on paracetamol.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

  • NSAIDs are medications that can reduce swelling around joints and nerve endings to give pain relief. They are particularly useful
    in treating inflammatory type pain. Two commonly prescribed NSAIDs are ibuprofen and naproxen.
  • Although NSAIDs can be very useful they are not suitable for everyone. Visit NHS inform for further information related to NSAIDs.

There are other forms of pain relievers available. If you feel your current pain relievers are not helping your pain or you are
experiencing any side effects from your medication, please seek advice from your GP or pharmacist.

For general information on medication visit NHS Inform.

Staying in work and returning to work

We know that staying in work or returning to work as soon as possible is good for your mental and physical health.

If you have problems with activities at work, it may be helpful to ask for a workstation/workplace assessment or talk with your manager or Occupational Health Department. This can help with alterations or provision of equipment or altering your working day or tasks.

There are organisations which can support you at work or help you return to work. You can visit Knowledge Scotland for further information.

Weight Management

Weight Reduction – People who are overweight tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve the healing process.

A good indicator of whether you need to lose weight is your body mass index (BMI), which you can calculate with the NHS BMI calculator.

If your BMI states you are overweight or obese it is likely that losing weight will reduce your symptoms. Carrying extra fat also increases your risk of heart disease, stroke, type 2 diabetes, and some cancers. Reducing your portion sizes and eating a balanced diet can be helpful in reducing weight. NHS informs provides a free online 12-week weight management programme to get you started right away.

If you need a little more help and feel that you would benefit from working with others in group sessions NHS Lanarkshire’s Weigh to Go programme, groups in North and South Lanarkshire, will help you become more active, eat well and lead a healthier lifestyle.

Smoking

Smoking can affect how your body recovers from musculoskeletal problems. If you smoke then the good news is that by stopping smoking it can improve your health in many different ways. Giving up smoking is not something you have to do on your own. You’re twice as likely to stop smoking successfully if you get the right support from the NHS. There is a free NHS stop smoking service available in Lanarkshire to help you succeed.

Chronic Pain

Some people will have pain which persists beyond the expected time frame for their condition. For further information on this and how best to manage it please visit our Chronic Pain webpage.

Pain Association Scotland is a national charity that delivers professionally led self-management pain education in the community.

Active Health Programme

South Lanarkshire

Active Health is a programme for residents of South Lanarkshire living with long term conditions. Residents are referred via Acute, Physio & specialist nurses to a 10-week programme and then signposted onto a wide variety of mainstream physical activity, sport & outdoor opportunities.

South Lanarkshire Leisure and Culture have many active community opportunities as well as specialised referral programmes. Full details of the 20 leisure centres can be found on the SLL website. Contact details across South Lanarkshire or call 01698 476262 to find out the number of your local leisure centre.

Please contact your health professional to discuss this referral or contact SLLC on 01698 476262.

Contact details

North Lanarkshire

North Lanarkshire Leisure’s Active Health Programme in partnership with NHS Lanarkshire provides a range of supported programmes to help individuals realise the benefits of becoming more physically active whilst also assisting those who are recovering from minor or even more serious illness.

The Active Health Programme has both a General Programme where individuals can access the mainstream health and fitness programmes running within NL Leisure Venues including swimming, jogging, golf and more!

A Specialised Health Class Programme which requires a referral from a health professional, this option is available to individuals who require additional specialised support in taking part in physical activity and classes include Strength and Balance, Cardio I, Cardio II, Back Care and Macmillan Move More classes.

A health and social care professional can make a referral by using the Active Health referral form found at the bottom of the page in the link below.

Contact Details - Health & Wellbeing Information

Mental Wellbeing

It is very important to look after your own mental wellbeing. This can have an influence on your recovery or management of your Musculoskeletal problem. Visit our mental wellbeing page for more information.

Your Feedback – comments, concerns and complaints

NHS Lanarkshire is committed to improving the service it provides to patients and their families. We therefore want to hear from you about your experience. If you would like to tell us about this please visit our feedback page.

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