Lateral Ankle Sprains and Physical Therapy
An ankle sprain can be defined as a partial or complete tear of the ligaments that support the structure of the ankle. Ankle sprains may be caused by falling, sudden twisting of the ankle or stepping on an uneven surface. One of the most common ankle injuries is a lateral ankle sprain.
RISK FACTORS: Understanding risk factors of spraining your ankle can help you avoid a nasty ankle roll. There is an inherent increased risk of lateral ankle sprains in individuals who: have a history of a previous ankle sprain, do not use an external support (like a brace), do not properly warm up with dynamic movement before activity, lack normal ankle dorsiflexion range of motion and individuals that do not participate in a balance/proprioceptive prevention program when there is a history of a previous injury.
DIAGNOSIS/CLASSIFICATION: To regain proper levels of function, your therapist should diagnose properly before they prescribe. Wright Physical Therapy (WPT) uses the clinical findings of level of function, ligamentous laxity, hemorrhaging, point tenderness, total ankle motion, swelling and pain to classify a patient with acute ankle ligament sprain.
TO TAPE OR TO BRACE: Two recent articles in the American Journal of Sports Medicine on ankle taping revealed that application of tape actually decreased the ability to detect movements of the ankle. It was concluded that the efficacy of taping is unlikely to prevent an ankle injury as successfully as a brace with the figure 8 sub-talar locking mechanism, e.g., brands like ASO. Aseparate article mentioned that by the end of the first quarter of a basketball game, the traditional athletic taping of the ankle had the same restrictive abilities as a “tight sock”. We are not saying taping is bad for ankles, but we are challenging the traditional beliefs in this being the golden standard. Our vote is to use a figure 8, stirrup ankle brace that locks the sub-talar joint. This will allow for longer lasting ankle support throughout a game and also removes the application error that is often seen in an ankle taping job.
EARLY WEIGHT BEARING WITH SUPPORT PHASE: Individuals with acute lateral ankle sprains should use lace up style external supports and progressively bear weight on the affected limb. The type of brace and gait assistive device recommended should be based on the severity of the injury,
phase of tissue healing, level of protection indicated, extent of pain and patient preference. In more severe injuries, immobilization ranging from semi-rigid bracing to below-knee casting may be indicated. At Wright Physical Therapy, we utilize a mobility to stability inverse diagram to help guide this process for quicker and more effective healing.
MANUAL THERAPY: Manual therapy procedures, such as lymphatic drainage, active and passive soft tissue and joint mobilization and anterior-to-posterior talar mobilization can be very useful for healing. These procedures are performed within pain-free movement, to reduce swelling, improve pain-free ankle and foot mobility and normalize gait patterns in individuals with an acute lateral ankle sprain. IASTM (Instrument Assisted Soft Tissue Mobilization) techniques are also effective in stimulating the damaged tissues and promoting healing.
THERAPEUTIC EXERCISES: WPT implements rehabilitation programs that include high-skilled and progressive therapeutic exercises for patients with severe lateral ankle sprains. Utilizing phases of progression and test out criteria to guide this process is crucial in a full and safe recovery. WPT uses weight-bearing functional exercises and single-limb balance activities (activity and sport specific) using unstable surfaces in order to improve mobility, strength, balance, coordination and postural control in the post-acute period of rehabilitation for ankle sprains.
RETURN TO SPORT (RTS): Before considering RTS the athlete needs to show proper progress and tolerance for dynamic and sport-specific exercises along with proper stability and control of the ankle. RTS protocols and testing need to be followed to ensure the athlete safely returns to sport with reduced risk factors for additional injury; this includes proper bracing or taping which was discussed above. Whatever bracing method is used, safety and reducing injury risk factors are the primary focus of the return-to-sport programs.
SUMMARY: Mild to moderate ankle sprains often heal well with the P.O.L.I.C.E principle https:// www.wrightpt.com/p-o-l-i-c-e-principle-of-tissue-healing/. For chronic instability or severe ankle sprains, advanced physical therapy is imperative for long term success of daily activities or sports. Specific protocols, proper bracing, and return to sport testing are a necessity to safely return to sports. Call us today at one of our convenient clinic locations to get to the root of your pain.