What to Do (and Not Do) When You Have a Sprain or a Strain

Saquon Barkley, star running back for New York Giants
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Last season, Giants star Saquon Barkley was diagnosed with a high ankle sprain, which saw him sidelined for a portion of the season. So what did this injury mean for Saquon and how soon can he expect to heal?

What is a High Ankle Sprain?

For starters, let's clarify the difference between a common low ankle sprain and a high ankle sprain. The ankle joint is formed by three bones in the lower leg: The tibia (shin bone), the fibula (outer bone next to the tibia) and the talus. The primary function of the ligaments in the ankle is stability. In the common ankle sprain, severity ranges from partial sprains to complete tears.

Athletes most commonly injure the anterior talofibular ligament (ATFL) when they “roll” the ankle with excessive force. Depending on the severity of the injury, athletes can return to sport as comfort permits with a step-by-step program with a physical therapist. A high ankle sprain is an injury that involves a different set of ligaments. These ligaments are located in between the tibia and fibula. This ligament is known as the syndesmosis. The primary role of the syndesmosis is to prevent the tibia and fibula from spreading too far apart. When you run and quickly change directions, the syndesmosis experiences extremely high forces.

The good news is: You can sometimes treat the pain of ankle sprains and strains at home. However, we checked in with David Garcia, DPT, OCS at AdventHealth Sports Med and Rehab, to determine when you need to seek out a medical professional, and what you can do to strengthen your muscles in your feet, ankles and any other affected areas.

“Sprains can affect any ligaments in your body, but they most commonly occur near your ankles, knees and wrists. Strains affect muscles, with common injuries effecting areas in your shoulders, legs and back,” says Garcia.

Sprains and strains can happen in a variety of circumstances. Everything from overuse injuries (working out/playing sports too long without proper rest) to twisting/pulling something to sustaining an unfortunate fall can lead to a sprain or strain. There's no one activity that causes injuries more than others.

How Sprains and Strains Happen

A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee may be the result of a sudden twist, and a sprained wrist can occur when you fall on an outstretched hand.

A strain can occur similar to a sprain, where it may be a simple stretch in your muscle or tendon; or it may be a partial or complete tear in your muscle/tendon connection.

What causes a high ankle sprain?

A high ankle sprain is caused by trauma to the syndesmosis, usually resulting from a sudden twisting or cutting motion while a person is running or jumping. They are most common in athletes who play high impact running sports like football, soccer, basketball and lacrosse. The best way to avoid this injury is continual performance training for strength and mobility training.

What Are the Signs of a Sprain?

  • Bruising
  • Decreased range of motion
  • Instability of the joint
  • Pain
  • Swelling

What Are the Signs of High Ankle Sprain?

You will typically feel a pain that radiates up your leg from the ankle. Each step you take may be quite painful. High ankle sprains do not typically cause a great degree of swelling or bruising. This can be frustrating for athletes because a high ankle sprain generally does not have the traditional look of a bad ankle sprain. For this reason, many people can be unaware of how severely they have injured themselves and may not rehabilitate as necessary for complete healing, putting them at risk for increased damage.

What Are the Signs of a Strain?

  • Bruising (either immediately or a few days later)
  • Inflammation
  • Muscle cramping
  • Muscle spasm
  • Muscle weakness
  • Pain

How Sprains and Strains Are Diagnosed

Most sprains and strains are diagnosed by a physical exam. Your medical professional will exam the affected joint or muscles and take you through your normal range of motion, watching for pain, tenderness, weakness or instability.

If there's a chance you've broken a bone, an X-ray may be ordered. An MRI may be needed to determine the extent of your injury because soft tissue, where sprains and strains occur, don't show up on X-rays.

How are High Ankle Sprains Diagnosed?

Your physical therapist will ask you what motion you were performing when your injury took place, assess your symptoms and conduct a physical exam. The exam may include a fibular compression test (also known as high ankle sprain test or syndesmosis squeeze test). For this test your physical therapist will place their hands on each side of your lower leg and squeeze the tibia and fibula together in a few different spots. If this causes pain that radiates down your leg, this suggests a high ankle sprain. However, additional tests may also need to be conducted to be sure you do not have a fractured fibula and determine the severity of the injury.

“It’s important to understand that because the structures involved in a syndesmotic sprain can lead to instability of the ankle, rehabilitation and recovery time can take much longer than a common ankle sprain. All ankle sprains are not the same. Recovery from a mild ankle sprain may take as little as several days whereas recovery from a severe high ankle sprain may take several months. Complete ruptures may require surgical intervention with a six-month recovery,” explains Garcia.

Healing Sprains and Strains

How long a sprain or strain typically takes to heal varies based on the severity of your injury and how much you're still using the area after the injury. Recovery ranges from a couple of days to a few weeks.

There are things that you can do in the first 24–48 hours to help alleviate pain and begin the healing process. You should implement the RICE principles: Rest, apply ice for 15–20 minutes, compress (not too tight) and elevate above your heart. If you don't see any improvement in a couple of days, you should see a medical professional to evaluate the extent of your injury.

“Physical therapy can help improve pain, motion, strength and recovery time. Also, it helps get you back to your normal activities quickly and safely, and you'll learn what to do, and what not to do, so you don't reinjure yourself,” explains David.

David continues, “Ankle injuries should never be taken lightly and are too often mistreated or not treated at all. This can result in an ankle prone to problems, prolonged discomfort and possible re-injury, which can mean further reduced physical activity levels.”

And with an injury that never gets better, whether it's your ankle or another area, it can become easy to slip into the habits that of a sedentary lifestyle, which can then to further long-term health complications.

Preventing Sprains and Strains

Regular stretching and strengthening exercises can help minimize your risks of sprains and strains and improve motion in all areas of the body. You can use a variety of stretching techniques to make sure you have full range of motion at all joints and lessen your chances of injuries too.

Progressive strengthening exercises allow you to better stabilize yourself during activity. Balancing exercises train your body to know where it is in space and reduce your injury rate. Other tips for preventing sprains and strains include:

  • Be in the right physical condition for the sport you're playing
  • Eat healthy to keep your muscles strong
  • Exercise daily
  • Keep a healthy weight
  • Try to exercise or play sports when you're alert and not tired
  • Wear the right shoes for the sport you're playing

For more information about sprains and strains or to speak with a physical therapist, visit AdventHealth Sports Med and Rehab.

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