Ankle sprains occur with the overstressing of one or more of ligaments of the foot and ankle, resulting in pain and dysfunction. Sprains mostly occur due to a specific injury or trauma to the ankle.
Ankle sprains most commonly occur with a rapid shifting of a person’s weight resulting in a mechanical stress to a weight bearing foot. This is commonly stated as “rolling” an ankle. The foot and ankle have several ligaments that are meant to provide support and stability for the ankle.
"Turning" or "Rolling" of the ankle in an accident may over-stretch the ankle ligaments. The severity can vary significantly. A simple Grade 1 may limit activity for one to two weeks while a Grade 3 may hobble you for up to two months. This is the most common injury physicians treat, and it has the highest rate of recurrence. Hence the need to ensure complete rehabilitation with physical therapy. This shift places excess stretch to the ligaments of the foot causing stress or tearing to the tissue.
Sprains may result in swelling and pain on the outside of the ankle near the ankle bone, limited movement, and sometimes inability to bear weight.
Acute sprains typically present with pain, swelling, and difficulty with placing weight on the ankle and leg due to pain and discomfort. They typically have point tenderness over the affected ligament and will be painful when a stretch is applied to the sprained ligament. More chronic cases may complain of pain, difficulty moving their ankle, and complaints of unsteadiness in their ankle with activities of daily living.
Physical therapist are trained to recognize and address the limitations associated with ankle sprains. PT’s will take patients through a thorough assessment focusing on range of motion, strength, and functional deficits like walking and weight bearing to help identify the sprained ligament. Depending on the severity of the injury imaging from a physician may be required to further assess the integrity of the ligament.
Physical therapy management of ankle sprains primarily focuses on assisting with the healing of the affected ligaments. PT’s will provide hands on treatments to help reduce swelling, improve weight bearing, and promote pain free ROM. As the ligament progresses and heals, treatment will typically shift toward strength and stability to help restore the ankle’s previous level of function. Athletes typically will be placed through return to sport testing to make sure the ankle is ready for the demands of their athletics.
Treatment begins with simple range of movement exercises and manual therapy to restore ankle joint mobility. Of more importance is the late stage of rehabilitation where exercises retrain the surrounding muscles to protect the ligaments from re-injury. This "proprioceptive" re-training is often overlooked by therapists and physicians, which explains the high rate of recurrence.
Appropriate warm up’s and stretching are key with prevention of ankle sprains with exercise and athletics. Supportive shoes can also reduce the chance of sprains in activities that required cutting and directional changes like basketball and soccer. Avoidance of uneven surfaces when running or walking can help limit the potential of a “rolling” injury as well.