February 4, 2022
Lateral Ankle Sprains
Lateral ankle sprains are a very common experience. This injury typically occurs when your foot comes in toward your midline and your ankle rolls out (this is what people mean when they say they “rolled their ankle”). This can take place whether you're out for a scenic nature walk on our Portland Trails system, playing pick-up basketball, or tripping over an unforeseen Tonka Truck that you’ve asked your child to put away about a million times. When you sprain your ankle, this means that the ligaments (connect bone to bone) that support your ankle have been injured. In order to determine the magnitude of the sprain, physical therapists use a grading system based on our expectations upon presentation. These grades range from mild (Grade I) to severe (Grade III).
|
Grade |
Description |
Signs and Symptoms |
Implications |
|
I (mild) |
some stretch/tearing of ligament |
-Mild pain -Little to no swelling -Some joint stiffness -No abnormal motion -Minimal bruising |
-Minimal loss of function -Early return to sport/training -Some protection (brace) may be helpful |
|
II (moderate) |
Some tear and separation of ligament |
-Moderate to severe pain -Joint stiffness -Structural weakness -Abnormal motion -Hemarthrosis (bleeding in the joint) -Effusion (collection of fluid in the joint) |
-Start to see recurrence here -Need protection from risk of further injury -May need modified immobilization (air cast) -May stretch out further with time |
|
III (complete) |
Total rupture of ligament |
-Severe pain at time of injury -No pain after injury -Profuse swelling and bruising -Loss of structural integrity -Significant abnormal motion |
-Needs prolonged protection -Surgery may be considered -Often permanent functional instability |
Table recreation of Table 2.4 in Dutton’s Orthopedic Examination, Evaluation, and Intervention, 5 ed.
What can we expect with an ankle sprain?
As shown above, it means that there are varying degrees of presentation with an ankle sprain. Despite these variations it is common to see deficits in the following areas:
- Strength-our ability to exert force when using our muscles.
- Balance-the ability to control our body position.
- Stability-the ability to restrict motion or decrease unwanted motion (such as buckling)
- Proprioception- the body’s ability to sense it’s movement, action, and location.
What does the evidence say about treatment?
According to our Clinical Practice Guidelines (CPGs), or a collection of data used to help guide clinician practice:
- There is strong evidence to suggest that early weight bearing is critical. This may or may not be done with external support (think crutches, ankle brace, air cast, walking boot).
- There is strong evidence in the use of cryotherapy (icing) which will be talked about in the POLICE section later on.
- There is strong evidence for the use of therapeutic exercise.
- There is moderate evidence in the use of manual therapy to reduce swelling, increase pain free range of motion, and improve walking capabilities.
What would a treatment plan look like?
During the initial phases post-injury, we want to use a new concept called POLICE. This stand for:
Protection- Finding ways to avoid future tissue damage. This may come in the form of external support (bracing, crutches)
Optimal Loading-This is so the healing process can start by stimulating the bone, tendons, and ligaments in question. This is different for everyone and can be based upon grade of the sprain, symptom severity, and a list of other factors.
Ice-Compression-Elevation- Immediately after injury and during the early stages, it is important to compress the ankle (with an ACE bandage), elevate the leg so that it is above our heart (our heart is fantastic at filtrating the excess fluid), icing to modulate symptom severity and prevent further swelling.
After this initial phase (typically 24-48 hours after injury), we can look at adding exercise as tolerated by the patient to further stimulate healing.
What are the risk factors for a recurrence of lateral ankle sprains?
Below are some of the risk factors found in our CPG:
- History of a previous ankle sprain
- History of an ankle sprain without exposure to balance and proprioceptive training
- Lack of dorsiflexion range of motion (the motion where you point your toes toward your head)
- Lack of proper warm-up, could be a dynamic or static warm-up
How can we prevent a lateral ankle sprain from happening again?
This is a great question. It is important to note that we cannot necessarily prevent the recurrence of lateral ankle sprains, but we can certainly reduce our odds from them happening again. Here are some suggestions:
- When participating in higher level activities or sport, consider using a dynamic warm-up to prepare your body for the task.
- If you do not feel 100% confident in your ankle’s ability to meet the demands of your activity (say there is a lot of cutting or lateral movement), you can use an external support, such as an ankle brace. We strongly suggest only using external supports as absolutely necessary.
- Incorporate exercises learned in physical therapy into your workout routine to ensure proper strength, balance, and proprioception of the ankle in question.
- Refer to a physical therapist if you feel you have the risk factors provided above, or lack the confidence in your ankle to perform daily tasks.
Citations
Dutton M. eds. Dutton's Orthopaedic Examination, Evaluation, and Intervention, 5e. McGraw Hill; 2020. Accessed January 05, 2022. https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=2707§ionid=224662235
Martin RL, Davenport TE, Paulseth S, Wukich DK, Godges JJ. Ankle stability and movement coordination impairments: Ankle ligament sprains. Journal of Orthopaedic & Sports Physical Therapy. 2013;43(9). doi:10.2519/jospt.2013.0305
Police principle. Physiopedia. https://www.physio-pedia.com/POLICE_Principle. Accessed January 5, 2022.
Author: Brandon Drinan, PT, DPT, CSCS
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