Did you know?

It is estimated that 55% of individuals who sprain their ankle do not seek medical treatment. Due to poor management, there is a high recurring rate with ankle sprains. Lateral ankle sprains are one of the most common orthopedic injury with a high recurrence rate.1

What happens when I have an ankle sprain?

When there is a sprain, there is a structural fault in the integrity of a ligament. The sole purpose of a ligament is a joint stabilizer. The anterior talofibular ligament is the most involved with a lateral ankle sprain. It is estimated that as much as 70% of individuals will experience repetitive ankle sprains which leads to chronic ankle instability (CAD). Chronic ankle instability can lead to articular degeneration and increase risk of osteoarthritis in the involved ankle.1

Common signs and symptoms of ankle sprains include:

  • Pain
  • Swelling
  • Redness
  • Bruising
  • Visible deformity
  • Difficulty with weight bearing tasks such as walking and standing

featured-ankle strengthPhysical Therapy

Research shows that early functional rehabilitation of the ankle with physical therapy can help return individual back to their daily functional activities and recreational activities faster.1,2,3,4,5,6 It is best that functional rehabilitation begins on the day of injury and is carried out until pain-free gait and return to full activity is achieved.7

What should I do before physical therapy?

There are various types of sprains that can occur at the ankle joint.

  1. Lateral ankle sprain: A lateral ankle sprain, also known as inversion sprain, occurs when the foot and ankle are stretched or twisted to the outside. A common mechanism is when a person rolls their ankle to the outside.
    a. Evidence shows it may be beneficial to wear an ankle brace or Air cast for 1-2 weeks after injury.
  2. Medial ankle sprain: A medial ankle sprain, also known as medial ankle sprain, occurs when the inside of the ankle is twisted or stretched too far. A common mechanism is when a person rolls their ankle to the inside.
  3. High ankle strain: An ankle syndesmosis sprain, also known as high ankle sprain, occurs when the ligaments between the lower leg bones are injured during a twisting movement. Symptoms of a high ankle sprain may include pain located above the ankle, pain with walking, and pain with outward rotation of the ankle.
    a. Evidence shows it is best to wear a boot for 6 weeks after injury.

Ankle sprains can range in severity based on the involvement of the ligament(s) and other structures. Based on the severity, treatment may start differently but all will require functional rehabilitation. Within each sprain, the severity of an ankle sprain can be described as:

  • Grade I: Partial tear of a ligament
  • Grade II: Incomplete tear of a ligament with moderate functional impairment
  • Grade III: Complete tear and loss of integrity of a ligament

With Grade I and II, it is best for early management to seek physical therapy, decrease swelling, maintain range of motion, and use a brace. While Grade III may require surgical intervention.7

Our program is:

  1. Designed to progress you through appreciate loading program for full return to activity based on patient symptoms and response to treatment
    a. Phase I: Optimize ROM and strength
    b. Phase II: Balance training and proprioceptive integration
    c. Phase III: Activity specific training
  2. Based on multiple research papers studying best intervention and appropriate progression following an ankle sprain1,2,3,4,5,6,7

References

  1. Hubbard TJ, Wikstrom EA. Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open Access J Sports Med. 2010; 1:115–122.
  2. Cleland JA, Mintken P, McDevitt A, Bieniek M, Carpenter K, Kulp K, Whitman JM. Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: A multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2013; 43(7): 443-455.
  3. Hoch MC, Mckeon PO. Joint mobilization improves spatiotemporal postural control and range of motion in those with chronic ankle instability. J Orthop Res. 2011;29(3):326-32.
  4. Hupperets MD, Verhagen EA, Van mechelen W. Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ. 2009; 339: b2684.
  5. Mattacola CG, Dwyer, MK. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train. 2002; 37(4): 413-429.
  6. Ochten JMV, Middelkoop MV, Meuffels D, Bierma-Zeinstra SM. Chronic Complaints After Ankle Sprains: A Systematic Review on Effectiveness of Treatments. J Orthop Sports Phys Ther. 2014; 44(11): 862-871.
  7. Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Physician. 2001; 64(3): 93-104