A Comprehensive Guide to Sprained Ankles: Causes, Signs, Symptoms, and First Aid Treatment

Ankle sprains are a prevalent injury in Australia, with a significant number of cases associated with various physical activities. Sports Medicine Australia reports that over 25,000 Australians sprain their ankles annually, a considerable percentage of these incidences stemming from sports activities. A thorough understanding of the common causes, recognition of the signs and symptoms, and the appropriate first aid response is crucial to mitigate long-term damage and expedite the recovery process.

Detailed Overview of Ankle Sprains

Ankle sprains occur when there’s a sudden twisting or forced movement of the ankle joint, causing an overstretch of the ligaments that provide stability to the ankle. The ankle joint is a complex structure composed of bones, ligaments, tendons, and muscles. Ligaments, tough bands of tissue, connect bones to each other and provide the necessary support to prevent excessive movement of the joints. When these ligaments are stretched beyond their limit of elasticity, a sprain occurs, leading to damage that ranges from a minor tear to a complete rupture.

Common Causes of Ankle Sprains

Ankle sprains commonly arise from several scenarios:

1. Awkward Foot Placement: Landing awkwardly from a jump, stepping on an uneven surface, or accidentally placing the foot at an awkward angle can result in an overstretch of the ankle ligaments, leading to a sprain.
2. Rapid Changes in Direction: Sports that require quick, abrupt changes in direction – such as basketball, soccer, netball, and tennis – predispose athletes to ankle sprains due to the high-pressure demands on the ankle joint during these movements.
3. Improper Footwear: Footwear that does not provide adequate support to the foot and ankle can also increase the likelihood of an ankle sprain. Shoes that lack good arch support, have worn-out soles, or are not a proper fit can all contribute to an unstable base and potentially lead to a sprain.

Signs and Symptoms of Ankle Sprains

Recognising an ankle sprain early on is crucial to streamline the treatment process and hasten recovery. The typical signs and symptoms of an ankle sprain include:

1. Pain: This may range from mild to severe, depending on the extent of the injury. It is often immediate and intensifies upon moving the ankle or bearing weight on it.
2. Swelling: The body responds to injury with an inflammatory process, leading to the accumulation of fluid in the tissues and manifesting as swelling in the affected area.
3. Bruising: This occurs due to broken blood vessels that leak into the local tissue in response to the injury.
4. Limited Range of Motion: The pain and swelling may cause difficulties moving the ankle, particularly in specific directions.
5. Instability: In severe cases, the ankle might feel unstable or weak, making it difficult to stand or walk.

It’s important to note that similar symptoms may occur in other severe injuries like fractures, hence seeking immediate medical attention is crucial for a proper diagnosis and management.

Understanding the Physiology of Ankle Sprains

When an ankle sprain occurs, the overstretched ligaments may tear, triggering an inflammatory response. This response involves a series of physiological changes including increased blood flow to the area, leakage of fluid into the surrounding tissues, and the release of certain chemicals that signal cells to multiply and repair the damage. Pain, swelling, and bruising are the visible manifestations of this inflammatory response.

RICER: The Recommended First Aid Treatment for Ankle Sprains

The gold standard in initial treatment for an ankle sprain involves the RICER protocol (Rest, Ice, Compression, Elevation, Referral):

1. Rest: Limiting or ceasing the use of the injured ankle is crucial to prevent further damage. Avoid putting weight on the injured area as much as possible. If necessary, use crutches or a supportive device to aid in mobility.
2. Ice: Applying a cold pack to the injured area for 15-20 minutes every 2-3 hours during the first 24-48 hours can reduce inflammation and numb the area, helping to manage pain. Avoid direct application of ice on the skin; use a thin cloth as a barrier to prevent skin damage.
3. Compression: Wrapping the injured ankle with an elastic bandage can provide support and minimise swelling. It’s important to wrap the bandage correctly: start from the end farthest from your heart and wrap towards your body, making sure the wrap is snug but not too tight to cut off circulation.
4. Elevation: Elevating the injured ankle above the level of your heart, as much as possible, helps control swelling by reducing blood flow to the area. This can be done by lying down and placing the ankle on a pillow or other raised surface.
5. Referral: After initial first aid, it’s essential to refer to a health professional for a comprehensive assessment and appropriate follow-up care. A qualified healthcare provider can provide an accurate diagnosis, assess the severity of the sprain, and guide you through a personalised recovery plan, which may include pain management, physiotherapy, and rehabilitation exercises.

In conjunction with the RICER protocol, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can also be used to help manage pain and swelling in the early stages following an ankle sprain. However, these should only be used under the advice and supervision of a healthcare provider, as they can have side effects and may not be suitable for everyone.

Severe ankle sprains, or those not improving with initial treatment, may require further medical interventions. This can range from immobilisation with a brace to physical therapy sessions aimed at restoring strength, flexibility, and balance in the ankle. In rare instances, surgical intervention may be necessary for sprains involving complete ligament tears or associated bone injuries.

The recovery timeline for ankle sprains can vary widely based on the severity of the injury and the individual’s overall health and fitness level. Minor sprains may begin to feel better within a few days to weeks, while more severe sprains can take several weeks to months to fully heal.

While the RICER protocol and medical treatments play a key role in managing an ankle sprain, prevention is always better than cure. Good practices such as proper warm-up and cool-down routines, wearing appropriate footwear, maintaining a healthy lifestyle to support overall bone and joint health, and following safety precautions during sports and other physical activities, can all contribute to reducing the risk of ankle sprains.

In conclusion, understanding the causes, signs, and symptoms of ankle sprains and the appropriate first aid response is key in effectively managing this common injury. Early recognition and appropriate management of ankle sprains are crucial in preventing long-term complications and ensuring a speedy and full recovery.

References

1. Sports Medicine Australia. (2023). Ankle Sprains in Australia.
2. Bleakley, C., McDonough, S., & MacAuley, D. (2023). Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review.