Ankle Sprain

Ankle sprains are common injuries that occur when ligaments are stretched or torn.  Most sprains occur laterally, or on the outside of the ankle joint.  Sprains on the inside ligaments are less common.  There are three major ligaments on the outside of the ankle that can be affected with a sprain:  anterior talofibular (ATF) ligament, calcaneofibular (CF) ligament, and posterior talofibular (PTF) ligament.  Think of ligaments as thick rubber bands that hold bones together so that joints are stable and function properly.  When these ligaments are stretched or torn, the ankle is less stable.  During an ankle sprain, muscles and tendons can be stretched as well, thus leading to weakness.  There are three different grades of an ankle sprain, depending on the severity of the injury.

Grade 1:  stretch and/or minor tear of ligament (usually only the ATF ligament)

Grade 2:  tear of ligament plus some laxity/looseness (usually involves ATF and CF ligaments)

Grade 3:  complete tear of ligament (ATF and CF ligaments, possibly PTF ligament); very loose  

 

Rehab Focus:  Four primary components of rehab are range of motion, progressive muscle strengthening, proprioceptive (stability) training, and activity specific training.

Initial Phase PRICE (Protection, Rest, Ice, Compression, Elevation)

These five treatments promote healing and decrease pain and swelling.  Cautious and gentle motion is initiated to help pump the swelling out of the ankle.  In more severe cases, the patient may be non-weight bearing and require the use of crutches.  Gait training is necessary to restore normal, pain-free walking.

Return to Function Phase Simulate appropriate stresses, forces, and motions inherent to activity that caused the original injury. As a guideline, you should be able to perform the following in order to return to your sport/activity:

  1. Full active range of motion (pointing foot and pulling foot up toward body)
  2. Single leg balance 3×30 seconds with the eyes closed
  3. Single leg heel raise x20
  4. Hop on one foot

Because it takes 16-20 weeks for a ligament to heal, ankle taping and/or ankle support (ex: ASO brace) should be provided for at least 5-6 months post-injury during athletic participation.  Appropriate ankle strengthening, range of motion, and balance/stability exercises should continue to be performed in order to prevent re-injury of the ankle.