• Robin R Varghese, PT.

Its another OUCH situation here!!! This time it is all about ankle sprain.

Updated: Nov 16


Ankle Sprain


An ankle sprain is a common injury where one or more of the ligaments of the ankle are partially or completely torn. In ankle, sprains can occur on the ligament on lateral side, medial side or the distal talofibular syndesmosis (A syndesmotic (high ankle) sprain).

Of the lateral ankle ligament complex the most frequently damaged one is the anterior talofibular ligament (ATFL). This happens during excess inversion and plantar flexion


On the medial side the strong, deltoid ligament complex which consists of posterior tibiotalar (PTTL), tibiocalcaneal (TCL), tibionavicular (TNL) and anterior tibiotalar ligaments (ATTL) is injured with forceful pronation and rotation movements of the hindfoot


A syndesmotic (high ankle) sprain occurs with combined external rotation of the leg and dorsiflexion of the ankle.


Are there Grades of severity for ankle sprains?

There are many grading systems used to understand the levels of severity.

Different therapists may employ different systems so effective continuity of care, the patient should see the same therapist each time.


  1. The traditional grading system for ligament injuries focuses on a single ligament

  • Grade I represents a microscopic injury without stretching of the ligament on a macroscopic level.

  • Grade II has macroscopic stretching, but the ligament remains intact.

  • Grade III is a complete rupture of the ligament.

2. Graded classification based on the severity of sprain injury.

  • Grade I Mild - Little swelling and tenderness with little impact on function

  • Grade II Moderate - Moderate swelling, pain and impact on function. Reduced proprioception, ROM and instability

  • Grade III Severe - Complete rupture, large swelling, high tenderness loss of function and marked instability

How can Physical Therapy be helpful in case of Ankle sprains?

Your therapists will use specialized tests to confirm sprains on your ankle or foot, if any.


Physiotherapy which focuses on functional therapy is required for more effective recovery than immobilisation alone. Functional therapy treatment can be divided in 4 stages. Progression to the next stage depends on tissue healing.

The stages are:

1. Inflammatory phase,

2. Proliferative phase,

3. Early Remodelling,

4. Late Maturation and Remodelling.


Physical Therapy Treatment


STAGE

DURATION

GOALS

TREATMENT

Inflammatory

0-3 Days

Reduce pain & swelling Improve circulation Partial foot support PRICE AROM exercises to improve circulation.

PRICE AROM exercises to improve circulation

Proliferative phase

4-10 Days

​Recovery of foot and ankle function and improved load carrying capacity.


Gradual increase in activity level, guided by symptoms.


Range of Motion


Active Stability

Motor Coordination


Tape/Brace: As soon as swelling subsides. Braces have proven to be effective than elastic support bandaging.

​Early Remodelling

11-21 Days

Improve muscle strength, active (functional) stability, foot/ankle motion, mobility (walking, walking stairs, running).

Patient education on preventive measures (tape or brace).

Advice on appropriate shoes to during sport activities


Foot and ankle functions.

Balance, Muscle strength and cordination exercises, ankle/foot motion and mobility, (walking, stairs, running).

Symmetric pattern of gait.

Dynamic stability as soon as loa -bearing capacity allows.


​Late Maturation and Remodelling

After 21 Days

​Improve the regional load-carrying capacity, walking skills and improve the skills needed during activities of daily living as well as work and sports.

​Motor coordination with mobility exercises


Progress to pre-injury load-carrying capacity


Increase the complexity of motor coordination exercises

It must be noted that during acute stage where there is inflammation, PRICE or Protection, Rest, Ice, Compression and Elevation will be the priority. Any exercises or activities that are done without the supervision of your physical therapist, especially during the acute phase may lead to further damage.


Based on the stages and the goals, your therapist will guide you with proper techniques and activities and make progression to the next consecutive stage. Lateral ligament injury has often led to Chronic Ankle Instability as a result of mechanical and functional insufficiencies. Therefore, the aim here should be to correct these insufficiencies.


Your therapist may use various tests to check your knee strength and mobility along with the static and dynamic balance. After these tests (which are used to find out if you are ready to get back to your sport) alone, will your therapist give you a green signal. Always consult your therapist before getting back to your sport as this will ensure your safe return without recurrent damage to your affected ankle.

We are specialized in treating all ankle related injuries. At Valley Healing Hands, Brownsville, Texas, we provide the best physical therapy care for Ankle sprains and Chronic ankle instabilities. Check out what our patients have to say about us and reach out to us for an evaluation. Patients love our services, You too will!

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