Ankle Sprains

Ankle sprain is the term used to refer to a strain or tear of one of the ligaments surrounding the ankle joint. Around your ankle there are a number of different ligaments that can be broken up into the lateral (outside) or medial (inside) groups. Ligaments are the bands of connective tissue that attach to bones at joints.

Ankle sprains usually occur during twisting of the ankle joint. A twisting inwards of the foot (inversion) causes a sprain of the lateral ligaments and a twisting of the ankle outwards (eversion) causes a sprain of the medial ligaments. A sprain of the lateral ligaments is much more common as they are much weaker that their medial counterparts.

Symptoms of an ankle sprain

A sprain of the ankle will commonly present with:

•    Mild aching to severe onset of pain depending on the severity of the sprain
•    Swelling and bruising of the ankle –usually most pronounced on the side that is sprained
•    Difficulty in moving the ankle
•    Pain in the ankle without weight bearing
•    Depending on the severity of the sprain there may be a decreased ability or inability to weight bear

Classification

Sprains may be graded according to their severity:

I – minimal ligament damage
II – moderate ligament damage with mild laxity of the joint
III –complete tear of the ligament resulting in an unstable/loose joint
Sometimes sprains may just be referred to as mild or severe depending on the damage

Diagnosis and treatment

Sprains can be diagnosed by your doctor or physiotherapist. With severe sprains x-rays are sometimes required to exclude any damage to the bones. Furthermore if a grade three sprain is suspected then further scans may be required to assess the damage to specific ligaments. In the case of grade three sprains surgery or immobilization in a cast may be required to prevent permanent ankle instability. Following surgery or immobilization your physiotherapist will be involved in the rehabilitation of your ankle and your return to sport/activity.

In the case of grade one and two sprains your physiotherapist will be able to rehabilitate your ankle. In the initial period following the sprain treatment will be aimed at reducing the swelling and pain as well as protecting the ankle from further damage. This may include electrotherapy modalities, gentle circulation exercises for the ankle, gentle massage, rest, ice, elevation and possibly the use of crutches to decrease weight bearing.

In the second stage your physiotherapist will aim to restore your flexibility, range of motion and strength. Typically treatment in this period would include manual therapy techniques, stretching, strength and proprioception (balance and co-ordination) exercise, strapping, massage and electrotherapy. Once range of motion, strength and proprioception has been restored then the focus of treatment will change to a return to sport. This may start off with a gradual return to straight line activities and then a gradual return to sports.