Ankle sprains are a common injury in both athletes and non-athletes. The most common type of ankle sprain is called an inversion sprain or a lateral ankle sprain. These sprains commonly occur when a person steps down and lacks stability in their weight bearing leg. The instability can result in the leg “rolling” outward while the foot turns inward. This result in trauma to the ligaments that support the lateral part of the ankle. Severity of the trauma varies significantly and can result in a strain, or tear of the lateral ligaments of the ankle.

Ankle sprains are classified into three levels of severity:

Grade I: Microscopic injury without stretching of the entire ligament. May see a small amount of swelling and tenderness but little impact on function, typically resolves in about 2 weeks.

Grade II: Ligament is stretched on a macroscopic level but is not torn. May see a moderate amount of swelling, bruising, and pain. More impairment seen in ankle stability, range of motion and function such as walking.

Grade III: Complete rupture of the ligament. High level of swelling, bruising, tenderness and pain. Significant impairments in stability, range of motion and function such as walking.

In addition to ligament sprains, a lateral ankle injury could result in trauma to other structures of the lower leg including the muscles, bones and joints. Sever ankle sprains can result in ankle fractures and/or muscle strains/tears. Depending on the severity of the injury, crutches, immobilization or surgery may be needed to support a full recovery. This is one reason why it is important to see a health care provider to help diagnose the severity of the injury.

Treatment

Initial treatment for ankle sprains may vary depending on the severity and will likely include physical therapy. The goal of physical therapy is to restore motion, strength and stability to the ankle.

A complete physical therapy plan should focus on:

• Stability and Balance

• Motor control

• complex movements such as running, jumping, pivoting

• Progressing toward return to sport

•  decreasing pain and swelling,

•  improving ankle range of motion

•  improving gait mechanics

•  improving loading tolerance

• Strengthening

  
  

While the majority of ankle sprains recover well, it is possible to develop long term issues such as chronic ankle instability. Some studies indicate as high as 20% of patients will develop chronic ankle instability after an ankle sprain. Although many people view ankle sprains as common minor injuries, research is showing value in early and progressive physical therapy to rehabilitate lateral ankle sprains and prevent chronic ankle instability. 

Take home message: Pain is not the best metric to judge your ankle rehab. Make sure you achieve adequate strength, range of motion and control in order to improve performance and limit the possibility of further injury.

References:

1. Martin, R.L., Davenport, T.E., Paulseth, S., Wukich, D.K., Godges, J.J. Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains. Journal of Orthopedic and Sports Physical Therapy. J Orthop Sports Phys Ther 2013;43(9):A1-A40. doi:10.2519/jospt.2013.0305

2. Al-Mohrej OA, Al-Kenani NS. Chronic ankle instability: Current perspectives. Avicenna J Med. 2016;6(4):103–108. doi:10.4103/2231-0770.191446