Acute Ankle Sprain

with Phase I Rehab

ExitCare ImageAn acute ankle sprain is a partial or complete tear in one or more of the ligaments of the ankle due to traumatic injury. The severity of the injury depends on both the the number of ligaments sprained and the grade of sprain. There are 3 grades of sprains.

  • A grade 1 sprain is a mild sprain. There is a slight pull without obvious tearing. There is no loss of strength, and the muscle and ligament are the correct length.

  • A grade 2 sprain is a moderate sprain. There is tearing of fibers within the substance of the ligament where it connects two bones or two cartilages. The length of the ligament is increased, and there is usually decreased strength.

  • A grade 3 sprain is a complete rupture of the ligament and is uncommon.

ExitCare ImageIn addition to the grade of sprain, there are three types of ankle sprains.

Lateral ankle sprains: This is a sprain of one or more of the three ligaments on the outer side (lateral) of the ankle. These are the most common sprains.

Medial ankle sprains: There is one large triangular ligament of the inner side (medial) of the ankle that is susceptible to injury. Medial ankle sprains are less common.

Syndesmosis, "high ankle," sprains: The syndesmosis is the ligament that connects the two bones of the lower leg. Syndesmosis sprains usually only occur with very severe ankle sprains.

SYMPTOMS

  • ExitCare ImagePain, tenderness, and swelling in the ankle, starting at the side of injury that may progress to the whole ankle and foot with time.

  • "Pop" or tearing sensation at the time of injury.

  • Bruising that may spread to the heel.

  • Impaired ability to walk soon after injury.

CAUSES

  • Acute ankle sprains are caused by trauma placed on the ankle that temporarily forces or pries the anklebone (talus) out of its normal socket.

  • Stretching or tearing of the ligaments that normally hold the joint in place (usually due to a twisting injury).

RISK INCREASES WITH:

  • Previous ankle sprain.

  • Sports in which the foot may land awkwardly (ie. basketball, volleyball, or soccer) or walking or running on uneven or rough surfaces.

  • Shoes with inadequate support to prevent sideways motion when stress occurs.

  • Poor strength and flexibility.

  • Poor balance skills.

  • Contact sports.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Ankle and leg flexibility, muscle strength, and endurance.

  • Cardiovascular fitness.

  • Balance training activities.

  • Use proper technique and have a coach correct improper technique.

  • Taping, protective strapping, bracing, or high-top tennis shoes may help prevent injury. Initially, tape is best; however, it loses most of its support function within 10 to 15 minutes.

  • Wear proper fitted protective shoes (High-top shoes with taping or bracing is more effective than either alone).

  • Provide the ankle with support during sports and practice activities for 12 months following injury.

PROGNOSIS

  • If treated properly, ankle sprains can be expected to recover completely; however, the length of recovery depends on the degree of injury.

  • A grade 1 sprain usually heals enough in 5 to 7 days to allow modified activity and requires an average of 6 weeks to heal completely.

  • A grade 2 sprain requires 6 to 10 weeks to heal completely.

  • A grade 3 sprain requires 12 to 16 weeks to heal.

  • A syndesmosis sprain often takes more than 3 months to heal.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms may result in a chronic problem. Appropriately addressing the problem the first time decreases the frequency of recurrence and optimizes healing time. Severity of the initial sprain does not predict the likelihood of later instability.

  • Injury to other structures (bone, cartilage, or tendon).

  • A chronically unstable or arthritic ankle joint is a possiblity with repeated sprains.

TREATMENT

Treatment initially involves the use of ice, medication, and compression bandages to help reduce pain and inflammation. Ankle sprains are usually immobilized in a walking cast or boot to allow for healing. Crutches may be recommended to reduce pressure on the injury. After immobilization, strengthening and stretching exercises may be necessary to regain strength and a full range of motion. Surgery is rarely needed to treat ankle sprains.

MEDICATION

  • Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take for the first 3 days after injury or within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your caregiver. Contact your caregiver immediately if any bleeding, stomach upset, or signs of an allergic reaction occur from these medications.

  • Ointments applied to the skin may be helpful.

  • Pain relievers may be prescribed as necessary by your caregiver. Do not take prescription pain medication for longer than 4 to 7 days. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver. Use a heat pack or a warm soak.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Pain, swelling, or bruising worsens despite treatment.

  • You experience pain, numbness, discoloration, or coldness in the foot or toes.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects.)

EXERCISES

PHASE I EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Ankle Sprain, Acute Phase I, Weeks 1 to 2

These exercises may help you when beginning to restore flexibility in your ankle. You will likely work on these exercises for the 1 to 2 weeks after your injury. Once your physician, physical therapist, or athletic trainer sees adequate progress, he or she will advance your exercises. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTHENING EXERCISES - Ankle Sprain, Acute -Phase I, Weeks 1 to 2

These exercises may help you when beginning to restore strength in your ankle. You will likely work on these exercises for 1 to 2 weeks after your injury. Once your physician, physical therapist, or athletic trainer sees adequate progress, he or she will advance your exercises. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist, or athletic trainer. Progress the resistance and repetitions only as guided.

  • ExitCare ImageYou may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band/tubing to a fixed object (ie. table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band/tubing should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band/tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band/tubing.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band/tubing across your opposite foot, slowly, pull your little toe out and up. Make sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your right / left foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist, or athletic trainer, add weight to the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.