What is a sprain?

A sprain is an injury that causes a stretch or a tear in a ligament. Ligaments are strong bands of fibrous connective tissue that connect bones at a joint. They are composed of bundles of Type I collagen and elastin. As ligaments insert into bones, the ligament material changes from rigid to more flexible. Sprains may be classified as grade I, II or III. Grade I sprains represent stretching of the ligament without tearing. Grade II represent partial tearing of the ligament. Grade III represent complete disruption of the ligament and often hurt just as much as a broken bone. A sprain of the lateral outer ligaments of the ankle is one of the most common injuries sustained with sporting activities. In fact, 85% of all ankle injures are sprains.

How does it occur? A twisting or severe stretching of a joint is the usual cause of a sprain. In regards to the ankle, a sprain occurs when an individual rolls over their foot onto the lateral ankle. What are the symptoms?

Often, one appreciates a pop or snap at the time of injury. This results in a swollen, painful joint. Following the injury, one may not be able to move the injured joint or have the ability to bear weight. The skin of the joint may be red at first followed by bruising in a few hours or days.

How are sprains diagnosed?

The diagnosis of a sprained joint begins with inspection of the injured joint to identify the location of swelling and bruising. This is followed by palpation of the bony and ligamentous anatomy to identify tenderness. An x-ray may be obtained to make sure you do not have a broken bone.

What is the treatment for sprains?

The goal of initial treatment is to minimize pain, swelling, and stiffness. The general rule for treating sprains is R.I.C.E. Additional treatment modalities include anti-inflammatory medications and physical therapy.

Rest- Depending on the severity of the sprain, the usual treatment consists of immobilization with a splint, brace or sling. In the acute inflammatory phase (1 to 5 days after injury) rest promotes pain control. Upon resolution of the acute inflammation phase, only submaximal activity is recommended, to prevent further injury or re-injury. Prolonged immobilization is discouraged because of detrimental long-term effects such as muscle atrophy and joint stiffness. Protected weight bearing is used until symptoms resolve. Modify your activities and avoid those that cause pain. Occasionally, sprains to the knee and ankle may require crutches for ambulation.

Ice- Cryotherapy, the application of ice, is recommended to ameliorate the effects of the inflammatory reaction by reducing swelling, hematoma formation (localized blood collection in the soft tissue) and diminishing pain. It is hypothesized that ice therapy retards hematoma formation and swelling because it constricts the capillaries and thereby decreases blood flow. Several studies have shown that cryotherapy can either increase or decrease swelling. Therefore, its affects on inflammation and swelling are unclear. Regardless, it is still highly recommended in the acute phase. Conversely, numerous studies have shown cryotherapy to provide an analgesic effect. It is believed to be due to breaking the pain cycle by showering the central nervous system with impulses, which makes the receptors momentarily refactory to pain. This analgesic effect is well substantiated. Although the duration of the effect is not well defined, the temporary analgesia is helpful for early mobilization. In the acute phase, one should apply ice on the sprained area for 20-30 minutes every 3 to 4 hours. Do this for 2 to 3 days or until the pain subsides.

Compression/Elevation- The use of compression and elevation are thought to decrease pain and swelling. Although there are no studies that address the use of these modalities, their employment is generally recommended. A elastic bandage or neoprene sleeve may be utilized to reduce swelling. Also, elevation of the injured joint above the level of your heart will decrease the swelling. Most severe sprains may require compressive bracing for up to 6 months during sports.

Nonsteroidal anti-inflammatory drugs (NSAIDS)- These medications have been used to reduce the acute pain caused by the inflammatory response. The inflammatory response involves the vasodilation of the vessels and collection of blood in the surrounding tissues. Inflammatory cells are recruited and result in swelling, redness, pain and impaired function. Although these effects are detrimental, an inflammatory response is not absolutely undesirable since a certain level of inflammation may be necessary to allow healing to take place. The current recommendation is to use NSAIDS immediately after the injury and a short time thereafter but not to continue for a long period of time to prevent interference with the healing response.

Physical therapy- Physical therapy is recommended after the resolution of the acute pain and swelling. This is beneficial for restoring normal muscle strength and flexibility around the joint. Therapy is important to prevent further injury or re-injury. Active assisted, passive, and resisted range-of-motion with gait, balance and proprioceptive training should be gradually instituted. The majority of patients will be able to return to full activity within six weeks of their injury. Some sprains with complete tearing of ligaments may need surgery.

How long should I wear an elastic bandage or pneumatic splint for an ankle sprain? The length of time depends on the severity of the injury, the activity involved, and the fitness level of the athlete. If the swelling is minimal, several days is usually sufficient. If there is an obvious hematoma or more severe pain owing to the swelling, a 6-week taping protocol or commercially available protective splint is recommended. The splint is discontinued when the person feels comfortable and confident. The exception is those who have chronic or recurrent sprains; in this case, continued protection whenever the person is participating in agility sports is recommended. How are sprains prevented?

Most sprains occur from accidents that are not easily prevented. However, make sure you wear proper shoes for your activities and watch for uneven surfaces when you are walking or exercising.

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