Ankle Sprains are one of the most common injuries; they comprise 14% of all sports related injuries and 50% of soccer injuries. Early treatment ensures a better outcome. Indeed, physiotherapy helps guide the healing process to facilitate a better recovery and prevent re-injury.
The most common mechanism of injury is rolling over on the outside of the ankle which sprains the lateral ligament complex. Athletes will often sprain the ligament when landing from a jump; especially when landing on another players’ foot.
There are three grades of ligament sprain. Patients with a grade one sprain have micro-tearing of the lateral ligament and will usually be able to weight bear after the injury. Grade two ligament sprains are accompanied by more swelling and visible bruising as the ligament fibers are more torn and there is definite instability. Weight bearing is painful and patient will usually hop off the field or court. They may require crutches for a few days. Grade three tears are significant with marked instability. They cannot weight bear and require crutches. Initially ankle mobility is greatly reduced due to pain.
Treatment varies depending on the grade of ligament sprains and the stage of healing. In the acute inflammatory phase the RICE method (Rest, ice, compression, and elevation) is employed. Taping and bracing are important to provide stability and prevent re-injury. Grade three sprains and severe grade two sprains require an air cast to immobilize and allow healing of the torn ligament. Moreover crutches are used for protective weight bearing. Specific active movement is begun in the first week and progressed to resisted strengthening exercises. Weight bearing is progressed as able. Eventually balance drills, hopping and running are given, usually around the fourth week for grade two sprains. Return to sport should be gradual and use of a braced is recommended.
Grade one ankle sprains resolve fairly quickly, usually in a week or two. Grade two sprains take 4 to 6 weeks and grade 3 sprains require a few months.
The goal of physiotherapy is to produce strong yet extensible scar tissue, regain normal strength and balance, and ultimately resume sporting activities without pain or dysfunction.
Written by Susan Reive, Owner of Kilborn Physiotherapy Clinic