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WHY IT’S NOT JUST A SPRAIN Most of us, at some point in our lives have experienced that painful and sometimes embarrassing moment when we’ve stepped off a curb, only to find that we have landed on the side of our foot instead of the sole. Usually that sharp pain will subside in a few minutes and we are no worse for the wear. But not everyone is that lucky. Just ask any basketball or volleyball player – they are the ones who can come up with good stories as to how many times they’ve sprained each ankle. The bruising, the swelling, the need for crutches – the stories may sound progressively more exaggerated, but the truth is the injuries worsen each time. So what happened when we stepped off the curb and felt the sharp pain? The ligament, the strong fibrous tissue that connects bone to bone and stabilizes a joint, was stretched beyond its normal limitations. Ligaments are designed to withstand a certain amount of stress, however, they are not like elastic muscle tissue; ligaments have “crimp,” meaning the fibres are bunched up like an accordion. Once the load on a ligament exceeds a certain point, the crimp is stretched out and the fibres break. When you “roll your ankle,” you are experiencing a quick stretch to those fibres, just enough to warn you that any more load on the ligament will cause damage to the tissue. In the case of a basketball player (keep in mind that ligament sprains can happen in any activity – even walking). They typically say they jumped up, and came down on their toes and on the side of the foot. Pain will be immediate and the swelling not far behind. A few hours later, bruising will start to show. Depending on the amount of stress the ligaments have sustained, three scenarios can happen: First is a mild sprain – similar to rolling your ankle, but the swelling tells us the fibres were stretched significantly. A moderate sprain results in some fibres actually being torn, and when tested, the ligament does not have the same resistance to stress. The worst case scenario is a severe sprain, where all the fibres have been completely torn and the ligament no longer supports the joint. Treatment at this time is RICE – rest, ice, compression, and elevation. Sometimes crutches are called for, although only for a day or two, and often an ankle brace is recommended. Physiotherapy can help reduce pain and swelling and maintain range of motion in this initial stage, but it plays a much larger role in assisting with healing and recovery. Ligaments do not heal by replacing the same tissue that was damaged. They heal by laying down scar tissue. Scar tissue is often formed in a mass, and is much weaker than the original tissue. Physiotherapy assists in the healing process by coaxing the scar tissue to form in a similar way to ligament fibres. This is important to make the joint as strong as possible and to prevent re-injury. Ligaments function to connect bone to bone, maintain joint stability and assist in balance and proprioception – that is, where the joint is in space relative to the rest of your body. Small receptors in the ligaments tell your brain what is happening at the joint – an injury can affect these receptors. For example, in an ankle injury, most people will exhibit a significant decrease in their ability to balance. It is a combination of poorly organized scar tissue, weak muscles, and poor propioception, which often leads to recurrent ankle sprains. Physiotherapy can help return balance and stability by strengthening the muscles around it and encouraging receptors in the tendons to take over this function from the defunct ligament. With trauma to any joint not only are ligaments damaged, but often muscles critical to function become inhibited and will not perform normally unless they are specifically retrained. This is particularly evident in the ankle, the knee, the low back and the neck. Your physiotherapist can identify the muscle dysfunction and teach you how to get those muscles going again, which will minimize the risk of re-injury. Sprains can happen at any joint – commonly we see them in ankles, knees and fingers. But the shoulder can also suffer sprains, as can the ligaments of the neck and back. It is important to get sprains addressed at the time of injury to ensure guided healing occurs. Failure to get adequate treatment to a sprained ligament increases your chance of re-injury. And with each re-injury, there will be more severe damage to the whole joint complex – including other soft tissues such as tendons and muscles, and even cartilage.