Ankle Sprain | Physiotherapy Management And Prevention.

Have you ever lost balance and suffered a foot twist, while landing on your ankle? If yes, then this is a condition of “ankle sprain”. If the ankle pain quickly disappears then you usually stop thinking about it but if the pain is severe, gives rise to swelling, and starts hurting on bearing weight, then it requires necessary treatment. Several interventions have been recommended in the management of acute ankle sprains, among them, physiotherapy has been recommended with a higher level of evidence and should be incorporated in the rehabilitation process.  The physiotherapy program includes exercises ranging from a simple range of motion, stretching, strengthening exercises to neuromuscular, proprioceptive, and sport-specific exercises. Through this blog, we will try to enhance your knowledge about ankle sprain and the various physiotherapy interventions which can be used as a treatment intervention for the same.

Ankle Sprain

Acute ankle injury is one of the most prevalent lower limb injuries occurring mostly in physically active individuals. An ankle sprain mostly occurs in females, children, and athletes taking part in indoor and outdoor sports. An ankle joint instability can occur due to the injury to the bone or muscular structures, ligaments like the lateral, medial, and syndesmosis injury play a major role in ankle instability. An ankle sprain occurs when one or more ligaments of the ankle are stretched or torn. If a sprain is left untreated, it can lead to long-term ankle problems. During Injury the ankle is either rolled inward or outward. Inward twisting injury sprains are the most common type, cause pain along the outer side of the ankle. Depending on to what extent the ligaments are injured, the sprain can be classified as Grade I, II, or III.

Ankle Sprain Classification

• Grade 1- Mild.
• Grade 2-Medium.
• Grade 3- Severe.

Grade I ankle sprain

• Rest: Take rest
• Ice:  By applying ice the swelling comes down. Apply it for 10 to 20 minutes after every 1 to 2 hours during the day.
• Compression:  Compression helps to control swelling and immobilizes the part to enhance the process of healing.
• Elevation: Elevate the foot by placing it above the level of the heart.

Grade II ankle sprain

• Follow the R.I.C.E. program and immobilize it by using a bandage or splint.

Grade III ankle sprain

• There is a risk for permanent ankle instability. Rarely, surgery might be required to repair the damage or put a short leg cast for two to three weeks or a walking boot.

Ankle Sprain Healing Goals:

• To relieve pain.
• Regain strength.
• Regain range of motion.

Once the patient starts to stand on the ankle again, the physiotherapist gives exercises to strengthen muscles and ligaments and increase flexibility, balance, and coordination.

Physiotherapy Treatment:

Depending on the severity of the ankle sprain, the physiotherapist designs a treatment program to enhance the healing process and advises to return to activities and sports.

The physiotherapy interventions include the use of ice packs, heat packs, modalities like TENS, Ultrasound, Shockwave therapy, and exercises like:

Range-of-motion exercises:

To move the joint as far as it can be in every direction.

Ankle alphabet

• Sit in a chair, with leg extended trace the letters of the alphabet in the air with the big toe. Repeat this 2 or 3 times, moving the ankle in all directions.

Knee motion

• Sit in a chair, place the foot flat on the floor. Then slowly move the knee from side to side for 2 to 3 minutes.

Stretching exercises:

To keep the Achilles tendon flexible while the ankle heals.

Standing calf stretch

• Stand in front of a wall facing towards it, put the hands on the wall. Place the injured ankle one step back and the uninjured foot forward. Keep the back heel flat on the floor, slowly bend the knee of the uninjured leg until a stretch is felt in the calf of the injured side. Repeat 3 times, hold for 30 secs.

Heel raise

• Stand with the hands in front, resting against the wall, or chair back for support. Place the feet shoulder-width apart, slowly rise on the toes and come back down.  Repeat 10 times then progress to 20.

Strengthening exercises:

To strengthen the muscles and support the ankle.

Elastic band push

• Sit on the floor.  Extend the leg and slightly raise it to 20 degree to keep the heel off the floor. Place the elastic band around the ball of the foot and hold the two ends. Slowly push the ankle forward by pointing the toe. Then slowly bring it back. Repeat this 10 times.

Elastic band pull

• Sit on the floor, hook the upper foot and the toes into the band.  Slowly pull the foot back towards the body and return it to a vertical position. Repeat 10 times.

Balance and control exercises:

To help the foot and ankle respond to activities, which can help prevent reinjury. Balance and control exercises should be started when there is no pain on standing.

One leg raise

• Place hands on a wall, lift the uninjured leg behind so that the weight rests on the injured ankle. Try to hold this position for 20 to 30 secs.

Pillow balance

• Do basic balance exercises while standing on a pillow.  The foot will wobble around a lot and constantly need to be corrected to maintain balance.  Maintain this position for 30 50 secs.

• To protect the ankle, bracing can be done and aids like crutches can also be recommended to avoid limping. With more severe ankle injuries a boot is recommended to allow proper healing.
• Ankle sprains almost take up to 4 months to heal completely, depending on the severity.  While playing sports ankle support like an ankle brace, air stirrup, or hiking boots may be recommended to be worn during the healing time to protect the ligaments. After the ankle is healed, taping can be done or an ankle brace to support the ankle.  To prevent reinjury continue stretching exercises especially before and after physical activities to prevent reinjury.  Muscle-strengthening exercises and balance exercises should be continued to maintain ankle strength. Long-term joint pain and weakness can be seen in people with severe or repeated ankle sprain therefore all the recommended exercises should be continued even after the pain the ankle mobility and strength are retained.