Treatment of Ankle Sprains in Soccer Players
Ankle sprains are the most commonly reported injury among soccer players and they are the most frequent reason that athletes visit the emergency room. A recent research study followed 312 amateur soccer players over a 2 year period. They found that most ankle sprains occurred as the result of a contact injury with another player. The study also found that defenders had a considerably higher injury rate compared with midfielders, forwards, and goalkeepers. Injuries were more likely to occur at the end of the game and in the first two months of the season and were just as likely to occur in practice as they were to occur in games. Field condition can also contribute to the likelihood of ankle sprains. Athletes that have sprained their ankle in the past are also much more likely to sprain their ankles again if they are not properly rehabilitated.
Ankle Anatomy
Movement at the ankle is actually a complex mechanism. What we normally think of as the ankle is actually made up of two joints: the subtalar joint, and the talocrural, or true ankle joint. The true ankle joint is composed of 3 bones; the tibia which forms the inside, or medial, portion of the ankle; the fibula which forms the lateral, or outside portion of the ankle; and the talus underneath. The true ankle joint is responsible for up and down motion of the foot. Beneath the true ankle joint is the second part of the ankle, the subtalar joint, which consists of the talus on top and calcaneus, or heel bone, on the bottom. The subtalar joint allows side to side motion of the foot. These bones are held together by ligaments. Ligaments are like thick rubber bands that hold bones together so that joints are stable and function properly. Depending on the degree on ankle sprain, a ligament can either be stretched, partially torn or completely torn. Over 90% of ankle sprains occur when the ankle is rolled inward too far resulting in damage to the ligaments on the outside the foot.
Treatment
Treatment for ankle sprains depends on the severity of the injury, but intervention should begin immediately with the RICE regimen: rest, ice, compression, and elevation. It is important to allow the joint to rest following a sprain and it’s always best to use ice rather than heat for the initial 48-72 hours following soft-tissue injury. Ice will control the inflammatory reaction and limit the swelling, which in turn, reduces the pain. The ice should be kept on no more than 20 minutes at a time and can be done hourly. Compression to the ankle using an elastic type wrap is essential to limit and control the amount of swelling that naturally occurs after a sprain. Elevating the limb above heart level also helps control swelling.
Medical attention should be sought if the ankle pain is severe or persists without improvement for more than a few days. Medical tests such as X-RAY may be required to determine if there is a fracture, especially if one is not able to tolerate their weight on the injured ankle. Even if an individual regains range of motion at the ankle joint and is able to weight bear without pain, the strength and stability of the ankle is often still impaired and would benefit from formal rehabilitation at an outpatient physical therapy clinic.
Physical Therapy (PT) is extremely beneficial in restoring an individual’s functional mobility as well as active joint stability after an ankle sprain, especially if you are involved in sport activities. Physical therapists teach specific exercises to assist the injured joint in regaining full range of motion, strength and stability. They may also perform manual techniques to promote normal joint mobility. Restoring proprioception, the ability to detect a joint’s position in space, is essential to promoting normal movement and preventing injuries in the future. Proprioception does not automatically return without training and must be relearned with specific balance activities.
The physical therapists at Baylor Outpatient Therapy and Sports Medicine in Frisco develop individualized programs for people of all ages and athletes of all levels and sports. The initial stages of PT for an ankle sprain focus on reducing pain and swelling, restoring range of motion and muscle flexibility, and low level strengthening. The focus progresses to weight bearing exercises that imitate more functional movements, balance training, and finally sport-specific movements that might include jumping, cutting, or running. Remember, correctly rehabilitating an ankle sprain, regardless of its severity, can greatly reduce the chances of re-injury in the future and keep you healthy and in the game for years to come.
Leslie Frater, PT, CSCS
Andrea Davis, PT, MS, OCS, CSCS
Baylor Institute for Rehabilitation
Outpatient Therapy & Sports Medicine Clinic @ Frisco
972.712.2669
Reference:
1. Kofotolis, Nikolaos, PhD. Kellis, Eleftherios, PhD. Vlachopoulos, Symeon, PhD. Ankle Sprain Injuries and Risk Factors in Amateur Soccer Players During a 2-Year Period. Am J of Sports Med. 2007. Mar;35(3):458-66.
2. www.scoi.com/anklanat.htm
3. http://www.apta.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=24759