Ankle sprains are one of the most common musculoskeletal injuries, making up 85% of ankle injuries and 15-45% of all sports related injuries. Whilst most ankle sprains affect the lateral (outside) ligament complex secondary to plantarflexion-inversion mechanism, syndesmotic and medial (inside) ligament complex sprains may also occur.
Symptoms
- Pain, tenderness and weakness around the ankle joint
- Swelling and/or bruising
- Difficulty putting weight through ankle
- Spasms or cramping of surrounding muscles
Diagnosis
- Grade I (Mild) – a few fibers are torn with possible mild swelling and tenderness with little impact on function.
- Grade II (Moderate) – Moderate swelling, pain and impact on function. Reduced proprioception, range of motion and instability.
- Grade III (Severe) – Complete rupture of ligament and possible capsular tear. Significant swelling and/or bruising. High level of tenderness, loss of function and marked instability.
Whilst all grades of sprain can impact on function and sporting performance in the short term, careful management and time to return to sport varies according to severity and can be anywhere between 1-24 weeks, depending on the grade of injury. Residual symptoms, chronic joint instability and recurrence can persist where rehab and management are insufficient. Consequently, comprehensive assessment and treatment planning is paramount.
Treatment
On your initial assessment the degree of severity will be established and a management plan formulated with your Physiotherapist, Chiropractor or Osteopath based on your mechanical and functional limitations, onset of injury, time elapsed since injury and rehabilitation goals. In the instance of a recurrent or a chronic injury particular attention will be paid to underlying intrinsic and extrinsic risk factors that may predispose compromised healing and a persistent problem.
Rehabilitation is crucial for the restoration of joint stability and dynamic ankle function. This will incorporate range of movement, strength and proprioceptive drills and functional recovery based on the inflammation, fibroblastic and remodelling phases of ligament healing.
Manual therapy techniques may also be utilised as an adjunct to rehabilitation as a means of restoring normal motion and improving function. In some cases the therapist may decide to refer to one of Blackberry Clinic Sport & Exercise Medicine Consultants for fluoroscopy or ultrasound to determine the extent of the injury. If necessary, an MRI can be ordered to make an accurate diagnosis of which ligaments are involved and the extent of the damage. This information can then be used to determine the process of rehabilitation and how quickly the patient can return to normal day to day activities and sport.
When can I return to sport?
It is recognised that high-level athletes demand faster rehab whilst ensuring the prescribed rehab criteria is fulfilled to reduce risk of further injury. Once range of movement, strength and proprioception have been restored, functional performance testing will be used to assist return to play decision making. This may include plyometric exercises, single legged hop for distance and the star excursion balance test. A maintenance programme once rehabilitation is complete may also be required in order to avoid the problem reoccurring. Your Blackberry Clinic therapist will be able to advise and guide you through each rehab stage and clinical trial return to sport.
Free Guide To
Treatment of an Ankle Sprain
The following leaflet outlines what you should
do immediately after you sprain your ankle
