Silvio Reffo’s advice on ankle sprains


«Ankle sprains are the most common trauma in the world of sports. Falling onto mattresses while bouldering, as well as the unstable terrain found along paths while approaching the crag, make the activity of climbing prone to these kinds of injuries.

The ankle is a joint made up of bones, ligaments and tendinous parts. The lack of muscles, the presence of only a terminal tendinous part and the fact that the joint bears all the weight of our body, are all elements which make the ankle prone to frequent injuries.

 

The sprain mainly occurs during an inversion, when the ankle gives in, and moves towards the inside and an important overload to the lateral tendinous-ligament occurs. 

The ligaments mainly involved during this event are the fibula, the anterior and posterior talus bones, and the tendinous part of the tibula muscles.

During the event a serious trauma must be excluded, finding out, straight away, if you are able to walk or not, and if there is strong pain while touching the leg, a few cms from the ankle or foot, in this case an X-ray is needed to exclude any fractures.

If instead, the trauma is not serious, it is best to recover and avoid a chronic instability, and a consequent relapsing numerous times.

At the beginning the priorities are pain control, and keeping the bruising under control if the ankle is very swollen.

1) INLAMMATORY PHASE 0-3 days

The fundamental points of this phase are:

  • Rest
  • Ice
  • A compression bandage
  • Passive movement elevating the limb
  • Adequate weight bearing (crutches if too painful, then progressive weight bearing)
  • Moving the joints

An adequate recovery of the injured tissue is necessary, especially through physical activity.

2) THE PROLIFERATION PHASE  4-10 days

During this phase it is fundamental to:

  • Recover the functionality and activity
  • Increase the ability to bear weight
  • Recover joint mobility
  • Recover strength and coordination
  • Walking as long as tollerated
  • Back to work when walking is back to normal
  • Strengthen triceps surae muscle with:

a) Bipodalic weight bearing

b) Monopodalic weight bearing

  • Recovering proprioception

 

Exercises to strengthen the triceps surae muscle, first with two feet and then on one foot (20 times x 3 sets)

 

 

 

 

3) PHASE OF PREMATURE REMODELLING 11-21 DAYS

  • Increase strength, active stability, walking and running
  • Balance and dynamic stability exercises

 

Exercises to improve balance and proprioception. Initially I can hold balance; 30sec x 5 times; carry out monosquat. 15 times x 3 sets

 

 

 

 

 

4) PHASE OF LATE REMODELLING

3-6 weeks

  • Sport-specific exercise
  • Gradual recovery of sporting activity

The programme and recovery times are obviously determined by the level of injury in the lateral compartment. It is fundamental to actively stabilize and strengthen the ankle to avoid experiencing repeated sprains.

When evaluating the injury at the beginning it is best to directly speak to professionals who are adequately trained to recognise any serious injuries which have to  be treated differently».

Article by Silvio Reffo