Feet First: Inversion Sprains

By James Baldwin
www.baldwin-osteopathy.co.uk

My first experience of Freerunning came when Jump London was first aired on Channel 4 way back in 2003. Like many people new to the sport I was attracted by the big jumps and practically superhuman skills on display. It was only when I began that I started to have an appreciation of the technical nature of the art of Freerunning; something honed by hours of repetition and a fanatical devotion to the perfection of movement. It was as a beginner that I experienced first hand the effects that this has upon the body, throughout the time I spent training I saw a good number of injuries (several of them mine) and the uncertainty almost all Traceurs/Freerunners demonstrated when dealing with them. I decided that this has to change; and so here follows the first in a series of articles which will examine common sports injuries, how to spot them and the best ways of dealing with them.

The ankle or talocrural joint is able to absorb incredible force and is the primary source of plantarflexion and dorsiflexion in the foot. It is also the most mechanically stable joint in the body; and yet despite this, Inversion Sprains of the ankle are a relatively common occurrence, especially in athletes engaged in high impact sports such as Freerunning. This article examines ankle inversion sprains, the different types, knowing when to RICE and when its time to visit your local A&E; plus a few tips and tricks to help you get back on your feet.

Ligaments are very good at resisting tensile or stretching forces; however they can become overstretched and even snap. An inversion sprain occurs when the Anterior Talofibular Ligament (located at the front of the ankle, towards the outer side) is damaged – in around 64% of cases this is the only ligament injured. The ankle is forced in to inversion, the: “going over on it” injury. It can easily occur when running, vaulting or landing from a jump; the pain is sudden, sharp and if severe can leave you feeling sick or dizzy. Pain may be felt in the ankle and foot, or may refer up to the leg. There may also be tingling or pins and needles in the ankle or foot.

Injury Grades:
There are 3 grades of Inversion Sprain, each more serious than the last:

As a general rule, if there are any signs of purple bruising around the ankle seek a medical opinion straight away; bruising can indicate a torn ligament or a fracture. Other signs of a fracture might be broken skin, bleeding, or ankle deformity.

Street Care
The first stop in caring for your injured ankle is RICE, which stands for Rest, Ice, Compression and Elevation.

Rest
It may be advisable to stay off your feet and avoid weight bearing for anywhere between 24-48 hours.

Ice
Using ice on the affected area is one of the best ways to limit the damage and reduce recovery time. The sooner the limb is iced the better; it helps to stop fluid building up (fluid slows the healing process) and constricts blood vessels which decreases any further bleeding. Ideally apply the ice for 20 minutes every 4 hours during the day (no more). It is always worth carrying a couple of instant cool packs just in case of need.

Compression & Elevation
Elevating the leg and using a compression wrap or stocking for the first 24-48 hours will also make a big difference. Following this advice can drastically reduce the severity of the injury and cut recovery time; meaning less time in pain and more time training.

Rehab:

Exercise
In the first 24-48 hours following the injury, it is advised for you to stay off your feet; keep up with regular applications of ice and elevate the leg as much as possible. After the 48 hours, weight bearing rather than rest is encouraged; it may be necessary during this period to wear a brace or support and in severe cases crutches can be used as well. Stick to walking (as often as is comfortable) in the first 5 days; dorsiflexion and plantarflexion movements can be done off weight bearing (within a pain free range). Attempt to resume normal activities as quickly as possible, but limit exercise to non-impact sports like swimming and cycling up to 3 weeks post injury.

After the first 3 weeks and up to 12 weeks it may be possible to resume sports if a brace or strapping is used to stabilise the ankle. Care should be taken to limit training time, stick with technical work that limits impact through the ankle such as low balance bars, small precisions and vaults; focus on improving skill and keep techniques low and slow. This may also be a perfect opportunity to build upper body strength with pull ups, dips and bar hangs.

Healing Time
Inversion sprains can commonly be painful for 6 weeks or more and though most heal well inside 3 months there is about a 20% chance that the ankle will become unstable. This means it can easily be re-injured, so taking the time to let it heal may be torture short term; but it will serve you better in the long run. After all, your feet are your link to the street, respect them.

James Baldwin M.Ost D.O.
If you have an injury and you want to know more about it, email:  osteo_bones@hotmail.co.uk

James Baldwin graduated with distinction from the British College of Osteopathic Medicine. He works from his Epsom and Fetcham practises in Surrey.

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