| Introduction Sprained ankles are one of the | | | | injury and the ligament has sustained a partial tear. |
| leading causes of athletes to miss games during | | | | The ankle will typically be more swollen and |
| the season. Many times they are taped up & | | | | ecchymosis (bruising) will usually occur. The ankle |
| rushed back to the field without proper | | | | will be more unstable and painful compared to a |
| rehabilitation. More often than not, the ankle gets | | | | grade I. |
| re-injured or worse, they end up with a knee, hip | | | | Grade III (3rd degree)- This is the most severe |
| or low back injury. These injuries can be | | | | injury as the ligament has been completely torn. |
| prevented by providing the proper healing time | | | | This is the most painful ankle sprain and will |
| and rehabilitation. The same premise holds true for | | | | typically present as very hot and swollen with a |
| non-athletes. I have worked with a number of | | | | lot of ecchymosis sometimes tracking halfway up |
| patients that have had multiple ankle sprains that | | | | the lower leg. |
| were never given the opportunity to fully | | | | Immediate care following ankle sprain - Following a |
| rehabilitate. The most common complaint is that | | | | turned ankle, it is difficult to determine the |
| their ankle turns over at any time without | | | | severity based on a number of factors. Swelling |
| warning. All it takes is a slight bend in the | | | | may occur immediately making the injury seem |
| pavement and the ankle turns. This type of injury | | | | worse than it actually is. If the ankle does not |
| is frustrating and can become debilitating. This | | | | swell, this does not necessarily minimize the |
| article discusses the different types of ankle | | | | possibility of torn ligaments. Tenderness will usually |
| sprains, what to do following a sprain, and what | | | | be present on the outside of the ankle with an |
| does rehabilitation of the ankle involve? | | | | inversion sprain. It also may be difficult to stand |
| Brief Anatomy The ankle is made up of three | | | | on the injured foot. The safest advice would be |
| primary bones. The tibia & fibula, which are | | | | to keep the shoe/sneaker tied tight to prevent |
| the longs bones of the lower leg and the talus | | | | the ankle from swelling. Keep the weight off the |
| which is a major bone of the foot. Together they | | | | foot as much as possible. When the shoe is taken |
| make up the talocrural joint. The mobility of these | | | | off, the leg should be elevated above the heart |
| bones allows the foot to flex and extend which is | | | | and an ice pack should be compressed against the |
| required for propulsion during walking. The other | | | | ankle. This will help decrease both the pain and |
| major joint of the ankle is formed by the lower | | | | swelling. This technique is called R.I.C.E standing for |
| portion of the talus and the upper portion of the | | | | Rest, Ice, Compression, Elevation. R.I.C.E is a good |
| calcaneus (heel bone). These two bones form | | | | pneumonic for any injury to the extremities. |
| what is called the subtalar joint, which allows for | | | | Should I go to the hospital? If you are having |
| movement in and out (inversion/eversion). This | | | | difficulty putting weight on the foot, if the swelling |
| inversion motion is the most common mechanism | | | | is severe, and the pain has not reduced after a |
| of injury. The ligaments are tissues that connect | | | | few hours of using the R.I.C.E technique, a visit to |
| bone to bone. Their function is to provide stability | | | | the hospital is recommended. Prepare to wait in |
| to the joint. There are three main ligaments on | | | | the emergency room for a while. Ankle sprains |
| the outside of the ankle called the lateral collateral | | | | are not usually treated as a priority. The doctor |
| ligaments. Their function is to prevent the ankle | | | | will examine the ankle looking for joint and |
| from inverting too far. The inside of the ankle is | | | | ligament instabilities. He/She may also order an |
| protected by the deltoid ligament, which functions | | | | X-ray to check for fractures. On occasion, an MRI |
| to prevent excessive eversion or turning out. | | | | will be ordered to assess ligament damage. |
| Mechanism of injury - The most typical ankle | | | | Physical Therapy/Rehabilitation It is common |
| sprain is an inversion sprain. This occurs when the | | | | following an ankle sprain to be placed on crutches. |
| ankle turns inward and the bodies weight | | | | More severe sprains are placed in a boot or air |
| compresses the ankle brining the lateral malleolus | | | | cast to help with ankle stability. There are four |
| close to the floor. This excessive movement | | | | major categories of impairments that occur |
| places the lateral ligaments on strain, stretches | | | | following an ankle sprain. These include 1. Ankle |
| the tendons crossing the joint and can also lead to | | | | joint instability due to weakened ligamentous |
| some of the tarsal bones compressing on one | | | | structures 2. Muscle weakness 3. Poor balance |
| another. The greater the inversion force results in | | | | (proprioception) 4. Pain and swelling. Each of these |
| a more severe ankle sprain or fracture. For the | | | | impairments must be addressed for a successful |
| purposes of this article, I will only be covering | | | | rehabilitation. Physical therapists will utilize various |
| ankle sprains, not fractures. | | | | massage techniques and modalities to reduce |
| What is the difference between a sprain and a | | | | inflammation. Manual therapy techniques will be |
| strain? This is a common question. A sprain results | | | | used to restore normal joint mechanics and to |
| from a stress placed upon a ligament. Remember | | | | retrain the proper muscle firing patterns |
| a ligament connects one bone to another bone. A | | | | necessary for stability. An effort is required to |
| sprain is a partial or full tear in the ligament or at | | | | normalize your walking (gait) as quickly as possible |
| the junction of where the ligament attaches to | | | | to prevent compensations. Finally, a specific |
| the bone. A strain results from an excessive | | | | strengthening program that incorporates the |
| force or overload on a muscle leading to | | | | entire lower extremity and core muscles is |
| micro-tears in the muscle belly or tendon. A | | | | provided to improve overall strength, balance and |
| tendon is a tissue similar in strength to a ligament | | | | coordination. Each ankle sprain is different from |
| that connects a muscle to the bone. Both | | | | the next & everybody heals at a different |
| ligaments and tendons are non-contractile tissue. | | | | rate. Typically, rehabilitation following an ankle |
| Only muscle has the ability to contract (shorten). | | | | sprain can be as short as two weeks (4 visits) up |
| Grading an ankle sprain There are three different | | | | to eight weeks (20 visits). This does not take into |
| grades of an ankle sprain based on the severity | | | | account any other co-morbidities. |
| of the injury. | | | | Conclusion Ankle sprains if managed properly |
| Grade I (1st degree)- This is the most common | | | | through physical therapy and a conscious effort |
| type of sprain. The ligaments are overstretched | | | | to comply with a home exercise program are |
| but no visible tear has occurred. Microscopic tears | | | | usually rehabilitated very successfully with low |
| have occurred that will heal if treated properly. | | | | chance of re-injury. However, if an ankle sprain is |
| Minimal swelling should occur and only minor ankle | | | | not fully rehabilitated, the chances of re-injury |
| instability will be present. | | | | with more severe damage increase greatly. |
| Grade II (2nd degree)- This is a more severe | | | | |