Ankle Sprains | Plenty Physiotherapy, Bundoora

Ankle Sprains Document

An ankle sprain refers to ligamentous injury due to  overstretching, tearing or rupturing, commonly occurring  from a twisting or rolling mechanism of the ankle. This  may happen to various populations of people who may  not only participate in amateur or high level sports, but  n individual person tripping on an uneven or  elevated surface. These injuries are classified based on  the anatomical structures involved and the severity of the  injury. • Lateral ankle sprain (most common): Injury to the anterior talofibular ligament  (ATFL), calcaneofibular ligament (CFL), and/or posterior talofibular ligament  (PTFL). This is the most common type of classification where people often will  roll their ankle inwards (inversion).  • Medial ankle sprain: Affects the deltoid ligament. • High ankle sprain: Involves the syndesmosis between tibia and fibula. Grading + Potential associated symptoms:  1) Grade 1: Microscopic tearing or stretching  of ligament fibres (Mild) a. Mild tenderness and swelling b. Minimal bruising c. No joint instability d. Able to bear weight with mild  discomfort 2) Grade 2: Partial tear of one or more  ligaments (Moderate) a. Moderate pain and swelling b. Bruising present c. Mild to moderate joint instability d. Difficulty bearing weight Grade 3: Complete rupture of one or more ligaments (Severe)  a. Severe pain and swelling b. Significant bruising c. Marked joint instability d. Unable to bear weightontributing Factors: - Previous ankle sprains (most significant risk factor) - Poor proprioception or neuromuscular control- Weakness in peroneals, tibialis posterior, or gluteals - Inappropriate footwear or poor surface stability (e.g. Grass, Sand, Turf) - Ligamentous laxity or hypermobility - Sports involving cutting, jumping, or landing (e.g., basketball, AFL, soccer) Treatment/Management:  Acute management🡪 1) POLICE method principals: Protect: Bracing/Taping/Moonboot or taping. OL (Optimal Loading): Weight-bearing as tolerated/Nil weight-bearing +- Crutches/gait aids. Ice: 15–20 min every 2–3 hours. Compression: Tubigrip or compression bandages to manage swelling and pain. Elevation: Ankle above heart height for swelling management.  2) Imaging/referrals: Starting with lower dosed over-the-counter non-steroidal  anti-inflammatories (NSAIDs), can help with the pain and excessive  inflammatory components that are associated with these sprains. Stronger types  can be recommended and prescribed as per your GP/Doctor. Over-the counter  pain killers can also be used to manage pain as required (as per medical team  recommendations). Imaging referrals in certain cases to see the extent of the  ligamentous damage and or to rule out any other sinister differentials such as  fractures. 

Rehabilitation/ Sub-acute management:rly tolerated mobility and strengthening:  - As tolerated gentle ankle motion movements  - Foundational ankle banded strengthening exercises as tolerated for the ankle  and lower limb. - Overtime there will be a tailored rehab program integrated to target your  specific sport/activity movements demands, whether it be by increasing the  weight, intensity or including agility/plyometric loads, you will progress  appropriately.  - Low impact as tolerated cardiovascular exercise  2) Manual therapy: Soft tissue work and dry needling in the tissue surrounding the  ankle joint to help with pain, normalised joint movement, swelling, tightness and  encouraging early healing. Joint mobilisations in the more sub-acute phase may  be utilised if the ankle joint becomes comparatively more stiff.3) Balance/proprioception: Working on specific deficits such as balance and  proprioception. This is important as proprioceptive nerve endings in these  tissues can be hurt and injured too. These proprioceptive nerve fibres help us  understand where our ankle is in space/awareness of the ankles positioning  when moving. It is important to work on this due to these reasons to help  minimise reoccurrence of ankle sprains. 4) Gradual return to activity/sport: Everyone will have different severities of injury  and progress and different rates. Each will also have different goals and  demands they need to reach. Due to this, your physiotherapist will guide you in a  safe and tolerated manner to get back to your daily life or sport.5) Medical: : In some scenarios, a referral to an orthopaedic surgeon may be  necessary if the injury is severe and involves multiple structures. It may also be a  valid option if the individual is not progressing as expected with their  conservative protocols. Your options will be discussed with your physiotherapist  specifically.