Woah! Did someone sprain their ankle?!

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Grade 3 ligament sprain

Now we've all sprained an ankle in the past, and probably also had one or two more memorable ones. But this, this definitely counts as a beautiful example of a Grade 3 ligament sprain - the most severe ligament damage you get. Ouch!

What is a ligament sprain?

Ligaments are fibrous connective tissue made from collagen connecting two bones together forming a joint.

A ligament sprain is a stretch or tear to a ligament.

Ligaments are designed to facilitate appropriate joint mobility; allowing adequate movement between the two bones, but limiting the joint range such that would cause instability or damage. A ligament sprain is where this tissue has been overstretched, or torn, typically as a result of the joint being forced beyond its normal range of motion.

How do we classify different types of sprains?

In order to determine the extent of the damage ligament sprains are classified as follows:

  1. Grade 1/mild sprain - Few ligament fibres torn, stability maintained. There is a local inflammatory response and pain at the injury site.
  2. Grade II/ moderate sprain - Partial rupture, increased laxity at the joint but no gross instability. There is more extensive damage to the collagen fibres and a noticeable inflammatory response.  Normally significant pain with associated joint effusion (swelling).
  3. Grade III/ severe sprain - Complete rupture, gross instability at the joint. Intense pain, significant joint effusion and bruising from associated muscle rupture - see the picture above!!

How do I treat a ligament sprain?

Well, normally if you have a Grade 2 or 3 sprain you'll probably have no choice but to seek medical attention. You'll have severe difficulty using the joint and will need to have an X-Ray to rule out the possibility of any fractures.

However most common ligament sprains are Grade 1 so follow this advice for the first 72hrs:

Make sure you follow PRICE

  • Protect the joint from further damage. Immobilise the joint, don't use it unless absolutely necessary.
  • Rest the ligament as much as possible. However you can begin to introduce any movement that is pain free.
  • Ice the joint - use an ice pack, or cover the ice, you don't want to have an ice burn as well as a ligament sprain!
  • Compress the joint using a bandage or support. This prevents unnecessary movement and helps reduce swelling.  Keep the compress on during the day and remove overnight.
  • Elevate the joint, preferably above your heart. This helps fluid to drain from the joint and promotes healing.

And avoid HARM

  • Heat. This encourages blood flow and swelling. At this stage this is NOT what we want.
  • Alcohol. Again this will cause swelling, and make you dehydrated. You will probably be taking some form of pain medication and mixing these with alcohol are not the best idea.
  • Running or strenuous exercise. Avoid anything that could cause further damage, simple
  • Massage. At this stage think of the ligament like an open wound, you don't want to encourage increased blood flow. Later though massage will be very effective.

How long before I am back up and running?

Well, we pulled this information from the interweb:

This answer provided for NATA by the California University of Pennsylvania Athletic Training Education Program.)

1. 5 to 14 days to recover from a grade one ankle sprain.

2. Grade two sprains can take 4 to 6 weeks to heal.

3. Grade three sprains can take 8 to 12 weeks to heal.

In our experience though return to full joint function can take up to double these estimates. You may find that the damage to the ligament has recovered during these time estimates, but the effects of the prolonged immobility, damage to other tissues, muscle atrophy, adhesion formation etc can mean that for a Grade 3 sprain a recovery time of 10-12mths isn't unreasonable. 

Get healing asap, ligaments have poor blood supply which is why their healing takes so much longer than muscles or tendons. And once are you are able to perform a decent amount of pain free movement, rehab, rehab and more rehab. Get that joint stable and prevent further ligament damage!!!

Follow Vicki:

Sports Massage Therapist

Vicki Marsh MSc BA (hons) studied at Oxford University before training as a Sports Massage Therapist. With over 12 years experience she specialises in chronic pain & complex cases as well as coaching Crossfit & Weightlifters.She runs specialist workshops, creates online courses and has spoken at events such as COPA on how to grow a successful business.

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