High Ankle Sprains

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. And we're going to talk about ankle sprains. How are you doing Wil? 

Wil: Hey, I'm doing well, thanks. 

Mark: So high ankle sprains or unique ankle sprains. What's that all about? 

Wil: Yeah. So this is a kind of ankle sprains that we usually see at the clinic from sport injuries usually. And the reason why it's more of a high ankle sprain, like someone in a ski boot you know, it's not your typical type of like just rollover obviously. Or someone that's playing football where they're in a scrum and they end up lying in a position where the ankle does this position of like a dorsiflexion where it's flexed towards your nose basically. And then it gets rolled over kind of thing. 

And so that kind of impact can sprain an area, so there's the distal being sort of closer to the ground and approximately closer to my head. So the distal portion of your what's called your tibia fibula or your ankle. So in your ankle, you have your two lower leg bones, your tibia, and your fibula. And that actually creates the roof, the dome of your ankle. 

Now that tib fib actually has ligaments that can actually get sprained when you get into that range or that mechanism of injury. 

Mark: So the ligaments in between the two bones, basically. 

Wil: Yeah, exactly. And it can be like something that's you know, I'll say mild for this kind of injury, to like something even more severe where it's like possible fractures to even tearing higher up into that area. It can go beyond just those ligaments to the connective tissue. 

Mark: So this is where the ankle has been flexed like you said, up towards your nose and typical causes. Why is it more with hockey and skiers and football players? 

Wil: Yeah. Basically when you put it into that range of motion, it actually causes more stress into that joint. And also there's nowhere else for it to go. So now it's basically, that's where it's got to go, that's where the force ends up.

Mark: So they're there in a boot on the side. So the sides are really well supported, but the front and back has to be moving because that's how, if you're going to ski or skate, you have to have that flexion. 

Wil: Or if you're say, playing football and you're a scrum or whatever, American football, I guess, or whatever kind of sport, and you end up in that position, like on your stomach or whatever, and then you get forced more, you know, and that can cause that to happen.

Mark: So how do you diagnose this? 

Wil: Yeah, so the presentation of how it happened is actually really important. And 10 out of 10 times, that's the mechanism of an injury. So I'll give you an example of a fellow who came in. He was a Triple A hockey referee, a junior hockey ref. And he was reffing a playoff match and he got his ankle in that exact same position, but he doesn't remember exactly how he went down. He went down, but he told me the position that his ankle was in. Which is exactly that same position and he's in a skate. 

And then basically he got hit, went down and then came in as an emergency assessment, a couple of days later and like all swollen up. So it was really hard to really determine exactly what was going on. But like, given that presentation that was very highly likely, and also like, you know, in a skate, you know. So that was sort of our number one. Yep. This is what we think it might be. And it could be this maybe.

And then as the swelling came down a few days later, we were able to actually apply specific clinical tests that actually can determine whether it is this or not really show, yep it is that. And we were able to know that this is probably more affected. And that's important because then that also guides with that more clinical diagnosis. We're able to now guide that treatment and know the healing and recovery timeline for this individual. 

Mark: So what's the typical course of treatment. I'm assuming that a high ankle sprain is a little bit longer recovery period than a regular. 

Wil: Yeah, for sure. At least twice as long, actually. So if you think of it like a mild ankle sprain, and usually if it's mild, you can pretty much start walking. You can even run on it. But for those ligaments and the swelling, when it's been torn, for that to settle down, it takes about four weeks. But it doesn't mean you can't do stuff.

Well with the high ankle sprain, with involving the distal tib fib ligaments and possibly even more, it's double that. So with a simple ankle sprain, you know, a simple tip fib ligament sprain, you double that, and then they may not be able to walk properly. That's the other important thing, like when you sprain it, because it's such an important aspect, weight bearing stability.

So when you injure it, there's usually limping immediately. And there's difficulty to walk on it, especially going on your toes. So we want to restore the range of motion. We want to make sure that we get the swelling down. It's very, very important to actually address the swelling and the mobility issues within the first two weeks.

So studies have shown that if you address that and you add a bit of manual therapy, so you're asking, what are the things that you typically do? You add manual therapy to, the RICE principle, which is rest ice compress and elevate, and then you also make sure that you get them moving on their own and basic strengthening for that range of motion that they have.

That actually has been shown to improve the mobility and get things going faster. And then the other thing now that we want to start to do, is that after we got that going for the first two weeks, then you can start to introduce a little bit more motion with typically like strengthening. You know, like with we talked about in an earlier segment about the motor retraining or muscle retraining. So we now need this stuff to retrain the muscle system related that whole ankle all the way up to the hip and the core. Not just specifically at that ankle joint. 

Mark: Is there anything that an athlete in any of these of higher risks sports to get this kind of injury can do to prevent it or minimize it, if an accident happens? 

Wil: Yeah, well, the research is really, really scant on this, but I would say that you need to really look at what your deficits are. So what I mean by that is like, okay, so first of all, if you have a preexisting injury and especially if it's like a lower body injury, pre-existing injury, then you might have some deficits that you're not really super aware of. So try to suss that out a little bit more. 

Like are you more inflexible like in your hip and then maybe your core isn't turning on properly. And that might actually influence, you know, if you're getting back into soccer. That might actually influence your ability to actually be more stable when you're running. 

Take this hockey referee, for example, if he wasn't really strong in his core, and he actually had been an existing client with us for other injuries. He had worked his way up to now at a high level of reffing. He had to really work on maybe his core strengthening, and these other issues, these pre-existing injuries. 

And that's the key. Is really looking at where, maybe I'm tight here, any tightnesses in any areas in the body, where it feels just a bit tighter, you know, not fully mobile like before. And it's not just, oh, I'm getting old kind of thing. There is a thing that you want to look at that. You want to pay attention to that. You don't want to be like, oh yeah, I'll be fine. Like it's not out of sight out of mind and you think, oh yeah, I'm going to get away with it. So you need to address that. And you need to look at that. 

Mark: If you want to get some treatment for a high ankle sprain, or you want some prevention treatment which is always a great idea, insyncphysio.com to book. You can book either the Vancouver, Cambie and King Edward office or the North Burnaby office on Hastings near Willingdon. You can call of course, to book as well. Vancouver 604-566-9716 or North Burnaby, 604-298-4878. Insync Physio will get you feeling better and moving better. Thanks Wil. 

Wil: Thank you, Mark.