By definition, a sprain is an injury of any of the ligaments (the tough elastic tissue that connects bones to one another) located in a joint. With ankle sprains, the ankle usually rolls outward, causing the sole of the foot to face the other foot (invert). Loose ligaments in the ankle; weak or nerve-damaged leg muscles; certain types of shoes such as spiked or high heels; rough and tumble sports like basketball, tennis, soccer, etc.; and certain walking patterns tend to allow the foot to roll outward, increasing the risk of a sprain.
A sprain results in pain and tenderness, as well as swelling and redness of the joint - the pain causes restriction in the movement of the joint. Sprains vary according to the severity of the stretching or tearing of the ligaments. A mild (grade 1) sprain, the ligaments may stretch but are not actually torn. The pain or the swelling may not be much, but the sprain may increase the risk of a repeat injury. In a moderate (grade 2) sprain, a ligament tears partially. Obvious swelling and bruising are common, and walking is usually painful and difficult. In a severe (grade 3) sprain, a ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint becomes unstable and unable to bear wait. Pain is more intense.
A quick trip to the hospital Emergency Room would be the wisest thing to do after a sprain. The doctor would usually conduct a physical examination of the joint to determine the extent of the ligament damage. He may also recommend an x-ray just to make sure there are no bone fractures or dislocations, this however cannot determine the extent of the muscle tendon/ligament injury.
Though treatment would depend on the severity of the sprain, following P-R-I-C-E would be the general rule in treating sprains -
Protection
Rest the joint as much as possible.
Ice Pack Application on the joint.
Compression with a firm bandage.
Elevation of the limb, if possible, to reduce swelling.
Mild sprains would require that the injured joint - ankle, wrist or finger, be wrapped with an elastic bandage or tape, with an ice pack applied to the affected area. Elevating the injured joint would help, but as the sprain heals, movement and exercise can be increased gradually. For moderate sprains, a walking cast is usually applied and left in place for 2-3 weeks, for a sprained ankle. This immobilizes the lower leg but allows the person to walk even with an injured ankle. For severe sprains, surgery may be needed. However, most doctors still opt to treat the injury without surgery using a walking cast for 2 to 3 weeks, leaving the ligament to heal naturally. Physical therapy has been proven to be helpful in restoring movement, strengthening the muscles, and improving balance.
Sometimes in moderate and severe cases, a small nodule may develop in one of the ankle's ligaments and cause constant friction in the joint, leading to chronic inflammation and eventually permanent damage. Injecting the ankle with corticosteroids to reduce inflammation and a local anesthetic to numb the pain often produces relief.
For less severe cases, Dr. Emiliano B. Tablante, a consultant at St. Luke's Medical Center and founding president of the Philippine Orthopaedic Foot and Ankle Society, would recommend pain medications such as Coxibs, like rofecoxib (Vioxx), which can help alleviate the pain and swelling. Coxibs or COX-2 specific inhibitors, a new class of pain relievers, have been clinically proven to effectively treat pain without causing serious gastrointestinal side effects commonly associated with other pain relievers such as NSAIDs (Non-Steroidal Anti-inflammatory Drugs). Traditional NSAIDs such as ibuprofen, diclofenac, aspirin, ketoprofen, naproxen, and other COX-1 Inhibiting medications, are prone to cause problems such as heartburn, nausea, belching, indigestion, peptic ulcers, even stomach perforations and bleeding - especially when these drugs are used on a long term basis.
During the sprain's healing and treatment stage, Dr. Tablante prefers rofecoxib because it can effectively reduce pain and swelling, can be used long term, can be taken with or without meals, and will not cause damage to your stomach lining. Clinical trials have shown that rofecoxib is also effective in the relief of various types of acute pain, such as post-operative dental pain, post-orthopedic surgical pain, and primary dysmenorrhea, as well as treating chronic pain brought about by osteoarthritis and rheumatoid arthritis.