An ankle sprain is a very common injury. Approximately 25,000 people experience ankle sprain’s each day. Even though ankle sprains are common, they are not always minor injuries. Risk factors for ankle sprains include previous ankle injury, poor balance and postural control, certain sports, lack of muscle strength and range of motion. Some people with repeated or severe ankle sprains can develop long-term joint pain and weakness. Poor ankle stability can contribute to other joint pain such as knee, hip and back pain. Getting a sprained ankle assessed and treated by a Physiotherapist has many benefits, such as:
- Resolve pain, swelling and loss of function quicker
- Restore proper movement, strength and biomechanics
- Give advice and promote safe return to sports activities
- Reduced risk of recurrent ankle sprains and ongoing ankle problems.
What Is An Ankle Sprain?
A sprain is a tear of a ligament. A ligament is an elastic structure that connects bone to bone and keeps them from moving too far apart. Ligaments have the ability to stretch with movement, but just a little bit. Just like an elastic band, after the ligament stretches, it then goes back to its normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. The duration and severity of the symptoms vary with the extent of damage to the tissues. In the ankle, we have 3 ligaments on the outside and 4 ligaments on the inside, each susceptible to being sprained. An outside ankle sprain is called an “inversion sprain”, where an inside ankle sprain is a “eversion sprain”.
Classification Of Sprains
Ankle sprains can range from mild, moderate or severe (complete) tear; depending on how badly the ligament is damaged and how many ligaments are injured.
Type I ankle sprain is a mild sprain. It occurs when the ligaments have been stretched over its normal limits or torn minimally (microscopic tearing).
Type II ankle sprain is a moderate level sprain. It occurs when some, but not all of the fibers of the ligaments are tor. If the ankle joint is examined and moved in certain ways, abnormal looseness of the ankle joint occurs.
Type III ankle sprain is the most severe ankle sprain. It occurs when the entire ligament is torn, creating complete instability of the ankle joint.
How Do Ankle Sprains Happen?
Most types of ankle sprain happen when you make a quick shifting movement with your foot planted on the ground, such as when you play soccer or get tackled in football. You could also sprain your ankle when awkwardly planting the foot when running, stepping up or down, or during simple tasks such as getting out of bed. Stepping on a surface that is irregular, such as stepping in a pot hole or uneven ground. Mild but repetitive stretching of the ligament can overuse the ligaments causing weakness of the tissue and potentially cause a tear. Think if it like an elastic band that’s been used frequently – it won’t be as strong or as tight as it was when it was brand new.
The most common type of sprain is an inversion injury, where the ankle rolls outward and the foot turns inward. This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle.
Signs and Symptoms of Ankle Sprains
- Pain right away at the site of the tear.
- Immediate swelling
- Significant bruising may occur depending on the severity of the sprain
- Difficulty walking and putting weight on you foot
- Tenderness to touch
- Decreased range of motion and pain with movement
- In more severe sprains, you may hear and/or feel something tear, along with a pop or snap.
Usually, the more pain and swelling you have, the more severe your ankle sprain is and the longer it will take to heal.
Our Physiotherapy Approach For Ankle Sprain Treatments
Step 1 – Thorough History & Assessment
The key to an effective treatment plan is to have the correct diagnosis. We start every management plan with a thorough history of your condition followed by a physical exam to ensure the correct diagnosis is made. We also rule out any medical condition for which further evaluation may be required. In terms of an ankle sprain, we first determine if it is a grade 1, 2 or 3 sprain. Then we determine if a referral to your doctor, orthopedic specialist or the need to get further testing is needed, such as an x-ray prior to treatment. Next, we discuss our findings and treatment options and together decide on a treatment plan. Once this is agreed upon, treatment typically starts on the first visit.
Step 2 – Pain Management and Decrease Swelling
Managing pain and swelling is usually the primary goal for patients with an ankle sprain. To help with this, we will choose the most appropriate from a variety of modalities. These modalities may include electrotherapy (interferential current, TENS), cold therapy, and manual techniques to help improve your pain.
Depending on the degree of your sprain you may need to use crutches and immobilize or splint your ankle, which ultimately will help to decrease pain and swelling.
Step 3 – Restoring Range of Motion and Strength
Increasing range of motion and strength is an important part of the rehabilitation process and crucial in reducing the risk of future injuries. Manual therapy techniques (passive range of motion, joint mobilization, muscle energy technique, and facilitation techniques) in addition to an exercise routine (including stretching and range of motion exercises) will help you to restore ankle flexibility and range of motion. Also, an individualized strengthening exercise program, targeting specific muscles will help to increase your strength, balance and overall function. Depending on your activity level, more advance exercises will be prescribed to gradually return to sports such as hockey, tennis, basketball, football, etc.
Step 4 – Restoring Function And Providing Walking Aids
Most patients with an ankle sprain will experience difficulty with certain activities, such as walking, sitting-to-standing, and climbing stairs. Restoring function is the ultimate goal of the physiotherapy treatment. As part of your rehabilitation process, a functional exercise program is designed to help you improve your function and facilitate your daily activities.
In some cases, ankle braces are recommended to improve pain and increase function. Our Physiotherapist will assess you particular case and make the appropriate recommendations.
Step 5 – Education and Self-Management
We believe that good communication and education is crucial in achieving positive outcomes. We educate our patients on their conditions, what to expect, and give you the proper tools to help with your recovery from home.