An ankle sprain is a common musculoskeletal injury that occurs at the ankle joint, its most common cause being overuse of the joint or the muscles that surround it.
An ankle sprain will involve a stretch or tear of the ligaments that support the joint. This usually happens when the joint is moved or stretched beyond its normal range of motion.
Classification of ankle sprains
Though there are several types of grading systems that can be used to grade an ankle sprain, the underlying one is most commonly used:
- Grade 1 – slight stretch and damage to the fibers of the ligament
- Grade 2 – partial tear of the ligament
- Grade 3 – complete rupture of the ligament
The PRICE Protocol
Though some might argue that it is outdated, the PRICE protocol is something that has stood the test of time.
It stands for – protection, rest, ice, compression and elevation. All of which serve their own purpose in the recovery and healing of a sprained ankle.
The use of crutches ensures that no extra weight is put on the joint until healing is complete, thus protecting it.
Rest ensures that the person is off their feet and Ice leads to a decrease in pain and swelling.
Compression involves the use of bandages and other supportive structures to ensure that the weight placed on the joint is well-balanced.
Elevating the affected joint will lead to a decrease in effusion and pain around the joint.
Physical Therapy Management of Ankle Sprains
The management of ankle sprains is broadly divided into the following 3 categories:
- Inflammatory phase
- Proliferative phase
- Remodeling phase
This phase lasts from the onset of injury till around the second or third day. It is the most painful phase with maximum effusion. The PRICE protocol is usually immediately implemented.
NSAIDS may also be used in this phase to deal with the pain after consulting with a medical practitioner.
Subtalar distraction, medial subtalar glides and lateral subtalar glides are some mobilization techniques that might be used either passively or actively. This will result in a reduction of pain, improved circulation, better reabsorption of oedema and prevention of venous stasis. This phase may sometimes last for up to 7 days.
Scar tissue begins to form in this phase. Hence the main goal is to improve ankle function with the help of gentle exercises. Increase the range of motion of the structures around the ankle joint, which can be achieved with the help of active or passive stretching. Improving the weight-bearing capacities of the foot by gentle loading of the foot through various exercises.
Additional support may be provided to the foot at this time with the help of a brace or an external fixator.
The rehabilitation program during this phase consists of practicing balance, muscle strength, ankle/foot motion and mobility (walking, stairs, running), looking for symmetric walk patterns, working on dynamic stability as soon as load-bearing capacity allows, focusing on balance and coordination exercises. Then gradually progress the loading, from static to dynamic exercises, from partially loaded to fully loaded exercises and from simple to functional multi-tasking exercises and use different types of surfaces to increase the level of difficulty.
Exercises for Ankle Sprains
Listed below are some common exercises that can be helpful after an ankle sprain
Range of motion exercises: These can be administered by the physiotherapist or may be performed by the patient at home, by himself. They assist in regaining the original strength and flexibility of the joint.
Stretching exercises: Standing calf stretches and heel raises are some common exercises that can be performed to help regain the original length of the calf muscles.
Strengthening exercises: Strengthening exercises must be practiced to increase the bulk of the muscle and prevent further injuries. Resistance exercises like the ones that can be performed with elastic bands are examples.
Balance and control exercises: These are probably the most important as they provide maximum protection. One leg raise, pillow balance and use of a balance board for exercises can be useful.