Ankle sprain rehabilitation:
An interview with a Mayo Clinic specialist
Ankle sprains are among the common injuries in athletes, both professionals and "weekend warriors." Metatarsal stress fractures, though less common than sprains, can also sideline athletes, especially those who run or jump a lot in their sport. We asked Edward Laskowski, M.D., co-director of the Mayo Clinic Sports Medicine Center, Rochester, Minn., and a specialist in physical medicine and rehabilitation to explain how to prevent and treat these injuries.
What is a sprain, and how does it differ from a strain?
We say that ligaments 'sprain' and muscles 'strain.' A ligament connects one bone to another bone. When a ligament is injured by being stretched excessively, it's called a sprain. A strain occurs when muscle fibers are pulled and torn.
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What's the first-line treatment for an ankle sprain?
We use the acronym PRICE to describe the first steps in treating any muscle or joint injury. It stands for:
Protect the injured limb from further injury. You can do this in a variety of ways, using anything from braces to crutches.
Rest the injured limb. Actually, the term I prefer is 'relative rest,' because even with an ankle sprain you are usually able to exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a peg. That way you still get three-limb exercise to keep up your cardiovascular conditioning.
Ice application with a cold pack, slush bath or a compression sleeve filled with cold water is the best way to limit swelling after an injury. Try to apply ice as soon as possible after the injury.
Compression is important as well. We often use an elastic wrap or bandage.
Elevation. Keeping the injured limb above heart level whenever possible may prevent or limit swelling.
Do you recommend that people take anti-inflammatory medication such as aspirin or ibuprofen immediately after an ankle sprain?
In this circumstance, I'm not a big fan of anti-inflammatory medications. Early use of these medications may actually cause increased bleeding into the area of injury because they make platelets, which help in clotting blood and sealing wounds, less sticky. So the PRICE approach is really the main thing we rely on.
If someone wants to take acetaminophen in the first couple days or so after an injury, that's OK. But if people apply ice regularly, they probably won't need any medication.
When should people get medical treatment for an ankle sprain?
If an ankle sprain causes significant swelling or makes you hobble, it's advisable to see a physician for a couple of reasons. One is to evaluate the severity of the sprain. Some sprains involve tissue disruption higher up on the ankle or bone fractures, and these need to be treated in a specific way. The other important factor is that we need to teach people how to restore stability to the ankle in a specific way.
We have an adage: 'Pain-free does not mean normal.' After a sprain, there's probably a decrease in your ankle's stability. Even if you get back to walking without pain, the joint may still lack normal stability.
What does stability training involve?
We suggest specific exercises. One exercise is to see how many minutes you can stand on the affected leg. To make this more challenging, you can close your eyes at the same time.
Another exercise is to dribble a basketball while you're standing on the leg with the recovering ankle. Or you can toss a ball, playing catch with someone while you stand on that leg. We also ask people to balance with one leg on a device called a wobble board a circular disk with a ball attached underneath it. We always like to say that the best brace you can give yourself is your muscle brace. If you develop muscle strength through specific exercises, that's the best protection you can give your ankle.
How can people prevent ankle sprains?
If you're playing a sport that requires a lot of cutting and pivoting, such as tennis or soccer, then the more you can practice those type of maneuvers, the better your muscles will be prepared to meet those demands. If you play soccer, for example, allow extra time to practice dribbling the ball and perform running and cutting drills.
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We also recommend stability exercises for prevention of ankle sprains as well as treatment.
Another common injury for active people involves stress fractures of the metatarsal bones. First, can you define the term stress fracture?
A stress fracture, as the name implies, results from an excessive amount of stress to a specific bone. Other fractures are acute the overload is applied in a significant fashion all at one time, causing the bone to break. In a stress fracture, the overload builds over time, and the bone finally breaks down.
And what are the metatarsal bones?
They connect the ankle bones to the toe bones. In essence, they are the bones of the forefoot.
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How do you treat metatarsal stress fractures?
Sometimes we recommend metatarsal pads that you put in your shoes. These are placed behind the metatarsal bones so that when you walk, your body weight comes down on the pad instead of the bone. In essence, this relieves the bone of mechanical stress. For other people we may use an arch support so that when they run or jump, the problem areas of the foot don't receive so much concentrated stress. In some cases of metatarsal stress fractures, we put people in a walking boot with a rocker bottom or rounded sole. We'll keep them in the boot, sometimes with crutches, to partially unload the limb and permit bone healing. As pain with weight-bearing resolves, use of the boot can be gradually tapered off.
When should people call a doctor to seek treatment of toe or foot pain?
If the pain just isn't going away if you wait until the morning after the injury and it's still making you limp that's the time to call a health care professional. I'm referring to persistent pain, with walking or at rest. Certainly if there's swelling about the joint or the toe, that's an indication to see your physician.
The bottom line is to call your doctor any time you experience prolonged pain in your toes or feet that causes you to alter your walking style. If that happens, it's time to have the injury checked out.
September 10, 2002
