Treating Ankle Sprains

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The high intensity of soccer demands athletes to engage in constant running, striking, cutting, and sliding. These actions often put players at risk for ankle and foot injuries.

Respond with R.I.C.E.

  • Rest, give your body time to heal naturally
  • Ice, 10-minute intervals every one to two hours
  • Compression, wrap with an elastic bandage
  • Elevation, above the level of the heart

Ankle sprains are graded as Grade I (mild), Grade II (moderate) and Grade III (severe). The amount of rehabilitation and recovery varies depending on the level of the sprain.

Grade I injuries stretch the outside ligament. This causes pain on the outside of the ankle with mild swelling and difficulty walking, but no bruising. Symptoms usually resolve within three days, and the athlete may return to participation as long as he or she is pain-free. If the symptoms persist or the athlete has sustained multiple ankle sprains, the athlete should seek medical attention.

Grade II and III sprains, as well as high ankle sprains, require immediate evaluation by a sports medicine physician. Grade II sprains involve a partial tear of the calcaneofibular ligament (CFL) and a full tear of the anterior talofibular ligament (ATFL). This degree of sprain limits the ability to walk, creates instability and causes local bruising and swelling. Furthermore, Grade III injuries involve the complete tear of both the ATFL and the CFL and prohibit weight bearing on the injured leg. Severe diffuse bruising and swelling will develop. Finally, high ankle sprains create pain on both the inside and outside of the ankle. This injury typically involves the ligaments connecting the bones above the ankle joint and may require surgery.

In order to recover most efficiently, it is essential athletes begin treating ankle sprains upon the time of injury, regardless of severity. Athletes can respond by following the R.I.C.E. acronym: Rest, Ice, Compression and Elevation. Rest is a critical component, as it allows the body time to heal naturally. Apply ice to the injured area in 10-minute intervals every one to two hours. (Note: Recent studies suggest that more than 10 minutes at a time may cause a reactive inflammatory reaction in the tissue.) To alleviate swelling and bruising, compress the ankle with an elastic bandage by starting near the toes and wrapping until the bandage reaches above the ankle. Finally, elevate the ankle above the level of the heart. In addition to R.I.C.E., athletes may take an over-the-counter anti-inflammatory medication or acetaminophen for the pain. Common treatments offered by a sports medicine physician for ankle sprains include prescription strength anti-inflammatory medications, immobilization with a walking boot or ankle brace, and referral to a physical therapist for a rehabilitation program. In fact, the most common cause of ankle sprains is having a prior ankle sprain that was not rehabilitated appropriately by a physical therapist with a strength and conditioning program.

Although most athletes fully recover from ankle sprains with no long-term problems, athletes need to take proactive measures to avoid these injuries. Developing good habits can alleviate unwanted pain and weeks on the sidelines. Encourage athletes to warm up on flat surfaces before engaging in any sports activity. Running hills can provide effective training. However, it needs to be done in moderation. Incorporating strength and conditioning programs that include exercises standing on a single leg at a time improves balance and strengthens the ankle. In addition, athletes must train and perform in good cleats, replacing them regularly. This way, we can minimize injuries and keep our athletes healthy on the field playing soccer.

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About Author

Ricardo E. Colberg, M.D.

Ricardo E. Colberg, M.D., is a sports medicine and non-operative orthopaedic physician at Andrews Sports Medicine in Birmingham, Alabama. He serves as team physician for the Alabama Soccer Association’s Olympic Development Program (ODP) and the Birmingham Hammers semi-pro soccer team.

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