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Explaining spraining

Nurturing

Why people sprain their ankles – and how best to recover

Health
Andrew O'Brien

After such a long, wet winter, the recent spell of fabulous weather has had everyone out and about; walking, cycling and, for the truly hardy, swimming. Over the bank holiday weekend, a cousin of mine who is starting a six-month journey from London back to New Zealand, via Africa, stayed with us for a week. To help her get fit for climbing Mount Kilimanjaro, we took her up the Reek. Our son desperately wanted to be a part of the action, so we decided that he could start, and one of us could turn around when he wore out. On the contrary, he set a cracking pace all the way to the top.
As is customary on the Reek, there was a constant concern for ankles. The rubber legs of a six-year-old handle that terrain much better than an adult, but we all made it down to the ice cream stand safely. Ironically, the following day a nephew sprained his ankle on a bouncy castle just as a client texted an enquiry about strapping tape for a long-term ankle injury. It begs the question, why do some people sprain their ankle and not others?

Why me?
Before we discuss the ‘why’, it’s worth looking at the ‘what’; what is a sprained ankle? In simple terms, a sprain is when you damage one or more ligaments around a joint. Ligaments are fibrous bands that run across joints to limit unwanted movement. So your ankle, which has to bend forward and back has ligaments on the sides to limit sideways movement.
Think of treading on an uneven footpath. On a small crack, your foot will wobble a little, but before you have realised, you catch your balance and keep going. In this instance, through a phenomenon known as ‘proprioception’, your body has read the surface and corrected your fall before it happens and before the ligaments are damaged. When the force is bigger and you can’t correct the error, the ligaments are loaded. Sometimes they stretch, or a small portion of the fibres tear, resulting in a Grade 1 sprain. Tearing half or more of the ligament fibres is classed as a Grade 2 sprain, while a Grade 3 is considered a complete rupture of the ligament. On top of damaging the ligaments, in severe cases it is possible to get a fracture at the bony attachment as well.
A low grade sprain can take as little as a fortnight to recover, whereas the more severe cases may need six to eight weeks to get back to normal. The bruising and swelling that come with a sprain can take some time to settle; it’s not uncommon to have a black foot long after the pain has improved. More serious injuries might necessitate a few days on crutches, but really it is best to get weight bearing and trying to walk normally as soon as possible after the injury.

No anti-inflammatories
In the first day or two, icing, compression and elevation are recommended, but not anti-inflammatories as they can impair the healing process. An X-ray is often not necessary, it may be best to consult your Chartered Physiotherapist before you spend a whole day in the Emergency Department.
As you improve, but also to protect yourself from injury, it’s important to work on your balance and proprioception, and the simplest way to do so is to stand on one foot. The Ministry of Defence in the UK expect soldiers to be able to stand still on their injured foot, with their eyes closed, for 30 seconds before they are passed fit to return to active duty. Try it, it’s much harder than it sounds, even on a good foot. Kilian Jornet, the Spanish alpine athlete reportedly takes it a step further by memorising a trail while running uphill then running with his eyes closed for 50 metre intervals on the way down. In the Pyrenees no less!
Hopefully the sun keeps shining and we all stay on our feet. If you are unfortunate enough to wobble an ankle, get it up and get some ice on it for a couple of days, then get up on it and get going as quickly as you can. For heaven’s sake, don’t get carried away and take on the Reek with your eyes closed though. Even prayers won’t help you then!

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.

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