Best steps to properly treating ankle sprains

I was recently reminded of the importance of early and proper osteopathic manipulative treatment for acute injuries when my son brought two friends to visit, one of them with a recently sprained ankle.

Sprained ankles are, of course, extremely common. The most common kind of ankle sprain is called an "inversion sprain," in which a person steps primarily on the outer edge of the foot so that the bottom of the foot points inward toward the opposite leg. This often results in minor or even complete tears in the ligaments (strips of connective tissue that hold bone to bone) of the outside (lateral) foot and ankle. The resultant golf ball- to baseball-size swelling and severe bruising are well known to most, especially athletes.

Although some injuries are severe, resulting in completely tearing through one or more lateral ligaments or even ripping off a piece of bone (an avulsion fracture), most ankle injuries result in minor- to medium-sized tears of the ligaments. Contrary to what you might think, the size of the swelling does not correlate well with the extent of the injury. Even minor ligament injuries can be associated with extremely large areas of swelling and purple discoloration.

Most doctors will examine the ankle, feel it, test the integrity and strength of the ligaments, and may even order X-rays to be certain no fracture has taken place. Once these common basics have been performed and fracture has been ruled out, however, treatment differences emerge. A majority of doctors will recommend things like ice, elevation, ace bandaging, or splinting. Those of us who regularly practice osteopathic manipulation and prolotherapy, however, frequently differ in approach.

In my practice, I will perform all of the above tests and order X-rays if the examination and symptoms warrant them. If there is no fracture, however, and the ligaments appear to be generally intact, I will then check the fibular head (which is frequently pulled backward during an ankle sprain) and I will "pop" the ankle. This resets the main anklebone (talus) in the mortis (the arch formed by the lower ends of the tibia and fibula). This repositioning allows proper motion of the ankle joint and more complete healing of the ankle ligaments. In many cases, as with my son's friend, the patient notes that the ankle immediately feels more stable and range of motion is much more normalized.

Failure to properly treat ankle sprains immediately often results in excessive pain (especially with walking), continued instability of the ankle, and the likelihood of recurrent sprain due to the failure of the injured ligaments to shorten back to their normal length and fully regain their strength. In rare cases, this can lead to the need for surgery or even complications such as chronic pain.

Immediate proper manipulative treatment of mild to moderate ankle sprains can shorten the recovery time and also reduce the need for supplementary treatments such as ankle wrapping or other mechanical support.

Dr. Cohn is employed at the Born Preventive Health Clinic in Grand Rapids, Michigan, where he is focused on treating acute/chronic pain and injury via osteopathic manipulation and prolotherapy. Dr. Cohn regularly blogs on medical issues and other issues of global and personal interest.