Ankle Sprains: The Injury and Prevention
by: Dr. Darrell M. Schreyer, D.C.

School has started for the year, and with it many sports as well. Training for sports such as football, volleyball, and track and field has already been established for a few weeks. The most common injury found in school sports is the ankle sprain.

The ankle suffers a sprain when it is over-stretched, happening most frequently when the ankle is in an unstable position. This instability occurs in plantar flexion, or when the toes of the foot are pointing in a downward position away from the shin. It is found that around 80% of these sprains that occur are when the foot is inverted, meaning the sole of the foot points inward while the weight is sharply transferred onto the lateral edge of the foot. This action most commonly occurs when walking or running over uneven ground, or in forceful uneven landings of the foot as those found in volleyball, basketball, or football when landing upon another players foot. The inversion sprain happens much more frequently due to the fact that the inside part of the ankle has one of the strongest ligaments in the body, which is so strong that it will usually cause a fracture of the bone rather than tear it's self.

The grading system used to evaluate an ankle sprain is based on the level of severity. A first degree sprain is one where the ligament is very slightly torn with little internal bleeding and no functional loss in the joint. A second degree sprain shows some tearing of the ligamentous fibers but the integrity of the ligament is not lost. There is, however, pain in the ankle and increased swelling with localized areas of tenderness about the area of the damaged ligament. A third degree sprain involves the complete tearing of the lateral ligaments of the ankle with complete loss of function and extreme swelling and hemorrhaging occurs. A rule of thumb in evaluating the extent of this injury is that the further back the pain in the ankle is, the more serious the injury is.

It is important for a trainer or physician to evaluate the sprain as soon as possible after it occurs. The first part of the evaluation is to dismiss any possibilities of fracture, then to make an anatomical diagnosis of the structures damaged and the severity of the injury. After proper evaluation, the first aim of treatment is to protect the ankle against further unnecessary movement. There can be soft tissue damage in the general area due to the extreme force of swelling and bleeding. The P.R.I.C.E method of icing that was explained in my past article on heat vs. ice is very important at this stage to diminish swelling as soon as possible. This icing of the injured area will also elevate the pain threshold by anesthetizing the nerve fibers and receptors in the area. If the patient cannot receive immediate attention, to control swelling it is sometimes better not to take the footwear off until aid arrives.

One of the most important part and yet the most neglected part of any injury treatment program is the part of rehabilitation. An athlete should be persuaded not to return to action too soon, as this type of injury can often repeat itself if not properly healed. The susceptible athlete should look to the addition of ankle wraps, or even better, taping the ankle before practice and games. Most team trainers or coaches should have the knowledge and skill to tape ankles to prevent further injuries.

As a doctor of chiropractic the most common problem I find with this type of injury is that though the ligaments, tendons, and muscles have been rehabilitated, the ankle joint has not been healed properly. Patients have presented with sprains from years ago that have never been returned to complete bio mechanical function. This is one reason that an injury of this nature can repeat itself so easily. Just like the bones of the spine, the smaller bones of the ankle joint are also susceptible to being forced and remaining out of proper alignment My special training in treating sports injuries and extremities allows me not only to locate these problems but to treat them effectively