How to “Un-Turn” Your Ankle

Very few people have not “turned an ankle” (sprained). With the fast tight cuts and turns of derby along with hits, skaters suffer sprained ankles all the time.

A sprain is literally an over-stretching and tearing of the bundles of fibers that make up a ligament. A ligament is a viscoelastic structure that connects bone to bone. If a ligament is stretched beyond its usual capacity, it is strained or it may tear in part or completely.

Ankles suffer sprains when the joint moves outside its normal range of motion. Usually, ankle sprains occur on the outside of the ankle; inside sprains and hyper-flexion or hyperextension sprains are less common. The “high sprain” is actually an injury of the fibrous connection between the tibia and fibula (the two bones of the lower leg) and is a more serious injury because of the instability it creates.

Ligaments are slow-healing tissues. The length of healing time depends in part on the amount of tearing that occurs. The healing involves a balance of different types of collagen (the main structural component of ligaments) forming to bridge the injury, similar to scar tissue. If the ligament does not form the correct balance of collagens, the ligament may be too loose or too tight. Motion of the ligament while healing is occurring tends to make the correct balance occur. Swelling in the injured tissues will slow the healing process and may affect the final ligament structure.

The immediate treatment for sprains consists of two components: a correct diagnosis and R.I.C.E. Your medical team should be able to decide if an x-ray is needed. About 85% of ankle sprains do not include a fracture so x-rays are not always needed.

The symptoms of a sprain usually are pain, some swelling and bruising, and difficulty bearing weight on the foot. If there is marked bruising and swelling, apparent deformity of the bones, tenderness over the bones of the ankle (as opposed to over the ligaments), and inability to bear weight at all, a fracture is suspected.

Rest is important and may involve use of crutches, air casts, taping, or ankle braces. Your medical team should be able to tell you what is best for the sprain you have. Icing is absolutely necessary because you must prevent or get the swelling down, and it relieves pain. This can be accomplished with ice bags or, even better, an ice bucket. Icing should be 15 - 20 minutes every few hours initially. A compression wrap will be used if there is no cast or taping, both to prevent and reduce swelling. Elevation of the injured ankle will also relieve swelling and reduce pain.

The importance of a thorough rehabilitation cannot be over-stressed. The three components of rehab are: mobility, strength and flexibility of the lower leg muscles, and balance. Although rest is stressed, inactivity is not. As soon as pain allows, the ankle should be moved through a range of motion. Writing the alphabet with your great toe is a good, usually not painful, way to start. Then as the pain allows, working with your medical team should include exercises for strengthening and improving flexibility in the lower leg muscles which support the ankle. Along with this, working on balance is critical. Ankle injuries tend to reduce the ability to sense your position in space; this obviously makes the likelihood of another injury high. Wobble boards and Bosu® balls are a good way to do this. During rehab, if the ankle is swelling or sore after the exercises, icing is very helpful.

For a number of weeks after the ankle is healed enough to resume skating, taping or ankle braces may be needed.

If you don’t have access to a trainer, coach, or physical therapist to help you rehab, here are two useful references:

1. http://orthopedics.about.com/cs/sprainsstrains/a/anklesprain_3.htm?p=1
and 2. http://www.mckinley.illinois.edu/handouts/anklesprain/anklesprain.html

Skate safe but when you do get the ankle sprain: RICE, rehab, and heal fast, ladies.