An injury can be defined as a physical damage or harm on an animal or human being. It affects the structure or function of the body and is caused by force either chemically or physically. Injuries are classified according to their cause like traumatic injury, infection, toxin, metabolic; the location like wound, nerve injury, cell damage, brain injury; and the activity like sports injury, occupational injury. They cause deaths and many of those who survive them incur temporary or permanent disabilities. They can be prevented and if they happen, their consequences can be mitigated.
Under the class of location, it can be found on an ankle with an example of sprained ankle. Ankle, being a complex supporting structure, if injured, it causes disability and absence from work. The ligaments in tibio-fibular joint in the foot enable to stabilize the forward motion. Basically, if they are damaged, their treatment will depend on how severe the injury is. This means that ankles are very useful in human body and there are many forms of treatment incase of damage but prevention is always the best. Their complications can cause arthritis, loose body formation and instability. In severe cases, that have to undergo surgery, 85% are successful and showed excellent results.
Ankle sprain is very common in sports and normal activities like work. It is the damage of the soft tissues around the ankle especially ligaments which can be torn or partially torn. It is also known as rolled ankle, ankle sprain or ankle ligament injury. It happens when there are abnormal motions like sporting activities, stepping on uneven surfaces, from a jump, falling, running, etc. It can include effects such as pain, swelling, and inability to walk. It can be prevented by wearing good shoes, focusing on the way we walk and run and paying attention to both internal and external warnings (Icon Health Publications 2002).
Ankle sprain can be classified in three grades depending on the force involved in causing it. In grade 1, it is a slight stretching which causes damage to the fibers and there is minimal swelling, joint stiffness, and mild pain which can be treated through isometric exercises and weight bearing. In grade 2, there is moderate tenderness, minor bruises, difficulty walking and possible instability which can be treated through therapy (physical). In grade 3, there is instability, ligament rapture, severe swelling and pain and can be treated through long physical therapy, surgery, reconstruction (Alan & Melvin, 2002).
It consists of inversion which occurs when there is too much inversion of the foot. It is rated to be 90% of all the sprains that happen and the most involved ligament is the anterior talofibular. Pain is more concentrated on the outside than inside of the ankle joint. The second type of sprain is eversion where the foot is twisted outwards hence the deltoid ligament is stretched too far. It causes pain inside the ankle. High ankle sprains an injury of ligaments like tibia and fibula. It occurs due to forced and sudden twisting of the foot (Icon Health Publications 2002).
Ankle sprains are associated with sports like soccer, football, volleyball and sprint racing. They both do vigorous exercises involving the ankles and sometimes jumping like in volleyball and basketball. In soccer, there is a chance that at least a player must suffer an injury especially, ankle sprain. According to FIFA ratings (2005-2010), the risk rate is 10% in soccer for an ankle sprain. The rate is not verifiable due to victims in different games; sometimes, 3 players suffer in a game while in other games none suffers. Actually, determining the risk rate at which people suffer may be difficult due to intervals, the severity and there causes. Many players have undergone surgery and others have had to take rest due to the sprains. The conservative measure is most used as players get injured, treated in the field and either get substituted or resume their positions (Alan & Melvin, 2002).
Some of symptoms of this injury are pain caused by sensitivity of the nerves and severe tenderness. There is warmth caused by increased blood flow and little ability or difficulty in moving the injured leg. Severe bruising and swelling can also be experienced and can be diagnosed through physical exam and x-ray. Physical exam shows laxity of the joint while x-ray shows instability. It can be confused for an ankle fracture which is caused by the same mechanisms. Mostly, in children, growth plates are mistaken for sprains.
Over time, ligaments that get damaged as a result of injury heal. This can only be possible to the minor injuries hence whenever there are cases of serious injuries; you should consult the doctor for diagnosis. He/she is to tell on the mode of treatment depending on the examination. Use of physical examination may be painful due to different twists in order to know the state of the ankle. A magnetic resonance imaging can be done to determine the severity of ligament injury, bone chip, fracture, joint surface injury or any other problem. It gives a correct diagnosis and can be done immediately at the point of injury or after swelling and bruising resolves (Icon Health Publications 2002).
The recovery is through treatment which aims at minimizing swelling, pain and inflammation while enabling recovery. Use of nonsurgical methods or conservative measures is advisable. If the injury was a grade 1, use of PRICE (takes between 48- 72 hours) is applicable which means Protect, Rest, Ice, Compression and Elevation. Protection is from any more danger or further injury. Rest means not involving the injured ankle in strenuous activities hence one can use crutches incase of making any movement. The recommended rest is between 48-72 hours.
Ice, although it can damage the skin if applied for long, helps in decreasing the blood flow to the damaged ligament. It is applied immediately or soonest possible after an injury for 20-30 minutes. It should be wrapped in a plastic bag, before pressing it on the skin else it will cause ice-burn and should not be left on while asleep. The time should not be less than 10 minutes because it will have no effect and not more than 30 minutes because it will damage the skin. Compression is with a bandage to limit swelling and should not be too tight to stop flow of blood. It should not be left on during sleep and should be removed as advised to allow free movement of the joint. Elevation is placing the injured leg at a strategic position, e.g. on cushions while lying on a sofa or on pillow while sleeping on bed to limit and reduce swelling and help recovery (Alan & Melvin, 2002).
It is also advisable to avoid HARM (takes 72 hours), meaning Heat, Alcohol, Running and Massage. Heat speeds blood flow hence should be avoided as long as there is inflammation after which, it can be used for soothing. Alcohol decreases healing and cause increased bleeding. Running can cause more harm to the injury while massage may increase bleeding. Gentle massage after 72 hours is recommended while running is only advisable after full recovery to strengthen the joint (Icon Health Publications 2002).
Doctors also advise on constant gentle movement of the joint by doing exercises every day which help it to regain its normal functions and prevent stiffness. Secondly, physiotherapy helps to improve proprioception which is the ability if the brain in connection to movement and position. In our normal activities, the ankle should be supported with a rigid sort with to help in healing of the damaged ankle. Finally, doctors warn against getting involved in vigorous exercises but encourage on allowing movement of ankle to a certain degree. It gives support to the joint (Icon Health Publications 2002).
All of the above can be done even without the help of a doctor but it is always advisable to see one incase the pain is so severe that it restricts movement, a ligament ruptured or on suspicion of a bone breakage. Also, if swelling and symptoms do not settle because in most cases, they take short time to ease and if there were severe bruises suffered. With assess of the doctor and use of x-ray, he /she can recommend the nonsurgical methods of treatment or surgical (Hammer, 2007).
Mostly, medicine may not be needed if pain can be tolerated but sometimes, nonsteroidal anti- inflammatory drugs may be used to control inflammation and pain. Some of the pain killers include: Paracetamol and codeine, anti- inflammatory painkillers. Paracetamol is used to relieve pain but incase it does not help, codeine is used which is stronger and can cause drowsiness and constipation. Anti-inflammatory include aspirin and ibuprofen which relieve pain and limit inflammation. Others are rub on which are similar to the tablets. Anti-inflammatory are not very advisable because they have severe side effects especially to people with high blood pressure, kidney failure, heart attack and asthma. We need to consult our doctors or pharmacists before taking these medicines (Alan & Melvin, 2002).
There are arguments that some inflammation necessitates healing. This is the reason why many doctors do not recommend use of anti-inflammatory painkillers within the first 48 hours of injury, they delay healing. It may only be theoretical because no one has proven this point. Only arguments and contradictions arise hence research is needed to prove it.
Rehabilitation helps to decrease swelling and pain and ensure that joint problems do not lead to chronic pain. To help pain and swelling, you can use ultrasound and electrical stimulation. It starts with simple exercises then extremity when and other exercises are added when you are pain free. It aims at improved balance thus proprioception training is important and increase in strength and range of motion.
The recovery depends on three phases:
Phase 1- resting reducing swelling.
Phase2 - restoring strength, flexibility and range of motion.
Phase 3- doing the less simple activities followed by vigorous and sudden activities.
In time course, 1-4 weeks is based on stabilized walking, 4-8 weeks, immobilization of ankles, 8-12 weeks, embrace of high level activities and 12 weeks onward, performance without external mobilization (Lewin, 2008).
Wearing of good costume for the purpose like boots during across country hike or when walking on uneven grounds or when rambling mountains would prevent or reduce ankle sprains. This is because they give support to the ankle as compared to other shoes. By visiting a physiotherapist, he/she can advise on the exercises to do so as to build muscles in order to prevent sprains. If it involved surgery, it should be resistant to nonsurgical. Surgical options include arthroscopy where the surgeon tries to figure whether there is any loose cartilage, ligament caught in the joint. The second option is reconstruction where the surgeon by use of stitches and other ligaments to repair the torn ones (Alan & Melvin, 2002).
Care should be taken on the way we treat or attend to an ankle sprain. This is because even a minor injury can turn chronic if not well dealt with. Most of the treatments of this injury are just conservative than medicinal. We should always seek doctor's diagnosis before taking painkillers. We can suffer injuries anytime any place thus we should always try and prevent it if possible and if it happens, we seek for the right recovery and rehabilitation.