1. What is the difference between a sprain and a strain?

A sprain is the stretching or tearing of ligaments, which are the strong tissues that connect bone to bone across joints, such as the ankle. A strain, often confused with a sprain, is a stretching or overuse of muscles and tendons. A strain is often described as a "tight muscle." Strains occur within the muscles when there is not a significant amount of time given to stretching, or "warming up," the muscle before activity.

2. What causes an ankle sprain?

Ankle sprains are the result of a sudden twisting and pressure on the ankle. Sprains happen when normal range of motion in the ankle is disrupted. They occur for several reasons but the most noted are activities such as running on uneven pavement or stepping in a hole, jumping and landing on someone's foot, playing basketball, slipping on wet surfaces, wearing loose footwear or excessively using a fatigued joint. Not listening to the body when it is tired increases the chance for an ankle injury.

3. How can an ankle sprain be prevented?

Stretching before activity, strengthening the muscles of the lower leg, and improving skills will help to reduce the risk for ankle injury. This will also build strength within the joint. Strong muscles will improve performance, reduce the risk of injury, and improve range of motion. Learning proper technique for exercise will improve performance and help prevent injury.

The following exercises should be completed wearing athletic shoes:

• Alphabet Range of Motion: A simple stretching exercise involves lifting the foot in the air and "writing" the alphabet with the tips of the toes. Hold the big toe rigid so that all motion comes from the ankle.
  Repeat exercise hourly, if tolerated.
  

• Ankle Lift: Take a piece of rope about 1.5 feet long and tie a 5-pound weight to each end. Sit on a stool to allow the leg to dangle and place the rope over the top of the toes. Use the ankle to lift the weight as many times as possible.
  

• Ankle Turn: While sitting on a counter, take a long piece of rope and place it under the arch of the injured foot. Hold the ends of the rope at about knee height. Slowly pull on the inside of the rope while turning the ankle outward resisting the pull of the rope. Alternate inward and outward movements until the ankle is fatigued.

• Toe Raise/Heel Drop: Stand on a bottom stair or on a thick book with the forefeet on the raised surface. Rise up on the toes above the level of the stair or book, then return the heels below the level of the stair or book, so that the back of the lower leg is stretched. Lift and lower repeatedly, holding each position for 10-15 seconds. Continue until the calf muscles become fatigued.

In addition to these strengthening exercises, protective bracing or taping can be effective at preventing ankle sprains in athletes. Most important for the prevention of ankle sprains is realizing that fatigue and pain are signs from the body to stop activity and rest.

4. How long does it take for the sprain to heal?

In ankle sprains that are stable (no torn ligaments), activity can be resumed as soon as pain and swelling subside and confidence in joint stability returns. This can vary from a few days to a few weeks. When damage to the ligament is more severe, healing may take from 5-8 weeks following the injury. Following a severe ankle sprain, recovery can take from 6-8 months.

5. Can the athlete return to his/her sport before treatment has been completed?

It is not recommended that the athlete return to his/her sport prior to the completion of rehabilitation. Athletes must gradually increase activity. The chance for re-injury to the ankle is increased when recovery is not complete. Re-injury to the ankle will limit healing so that strength in the joint may not fully return to the pre-injury state. When treatment is completed, physicians recommend supporting the ankle by taping or using a re-usable lace-up brace for at least 6 months following injury.