Ask The Expert: How Do I Treat My Sprained Ankle?

March Madness is upon us! With the mania of pursuing the college basketball crown, many teams are plagued by injuries throughout the season and especially during the NCAA Tournament to reach the Championship game. Ankle sprains are among the highest injuries facing basketball players and many of the athletes we see at VTFC.

WHAT IS AN ANKLE SPRAIN?

An ankle sprain is when the foot rolls, twists, or moves beyond its normal range of motion, overstretching the ankle ligaments. This is not to be confused with a strain which is an injury to a muscle or tendon.  A sprain is an injury to a joint ligament. An ankle sprain is graded by the extent in which the ankle ligaments are injured.  The injury can cause damage to ankle ligament fibers causing microtears (Grade 1), partial tears (Grade 2), or a complete tear of one or more ankle ligaments (Grade 3).

HOW IS THE SEVERITY OF THE ANKLE SPRAIN DIAGNOSED?

Physical therapists, Athletic Trainers, and Orthopedic Physicians are skilled to perform specific tests of the ankle ligaments.  These ligament stress tests combined with the symptom presentation will likely determine the severity of the ankle sprain.

Grade 1: Microtrauma to the ankle and ankle ligaments.  No laxity (ligament movement) with ligament stress tests.

Grade 2: Partial tear to one or more ankle ligaments.  Some laxity (ligaments overstretched) causing some decreased joint stability.

Grade 3: Complete tear of one or more ankle ligaments.  Significant increased joint motion allowing dysfunctional joint movement.  No end feel in one or more ligaments, when ligaments are tested. causing a significant increase in joint mobility and compromising ankle joint stability.

High Ankle Sprain: A high ankle sprain is a sprain to the connective tissue (syndesmosis) between the two lower leg bones (tibia and fibula).  The lower portion of these two bones forms the structure of the ankle joint. Damage to the this area reduces the stability of the ankle joint and can slow recovery timelines.

Once the severity of the ankle sprain is diagnosed a proper treatment plan can be determined.  The severity of the ankle sprain will often times dictate the length of recovery time before the athlete can return to the court.

COMMON SYMPTOMS OF ANKLE SPRAINS INCLUDE:

• Pain
• Swelling in the ankle, foot, and/or toes
• Tenderness to touch
• Bruising or discoloration in the ankle, foot, and/or toes
• Inability to put weight on affected ankle
• Skin discoloration
• Stiffness

HOW CAN A PHYSICAL THERAPIST HELP?

Early diagnosis and treatment are key to a quicker return to sport and activities.  We have been able to treat  less-severe  grade 1 ankle sprain with a quick return to play timeline of 1-3 days.

Treatment for ankle sprains involves some rest, but proper amounts of exercise and loading of the ankle will provide an Optimal Stimulus for Recovery (OSR).  Additional treatment will include

• Modalities to control pain and promote healing
• Early movement/safe loading
• Joint mobilizations and strengthening of the ankle, foot, knee, and hip
• Electrical stimulation to facilitate the Peroneal muscles

A functional progression of increasing athletic movements is necessary to determine when the athlete is ready to return to sport.  Normal healing times for ankle joint connective tissue will take up to 6 weeks.  There is a higher incidence of repeat ankle sprains if proper rehab and recovery is not followed.  Therefore, players will need to protect their ankles while they are playing with either an ankle brace or tape.