Ankle strains

Ankle strains are a result of the ligaments of the ankle stretching beyond their limits. Ligaments have elasticity but when a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.

With an ankle strain, there is an excessive turning of the foot relative to the ankle causing the ankle ligaments to stretch beyond their normal length. If the force is too strong, the ligaments can tear. Pain, bruising and swelling often result. Tears of the ligaments are graded as follows:

Grade 1 sprain: Slight stretching to the fibers of the ligament.

Treatment includes careful walking. Weight bearing upon the ankle is permitted as tolerated. Although this level of sprain does not splinting or casting, it is prudent to support or protect the ankle with use of an ace wrap or soft ankle support for 1-2 weeks. Performance of isometric exercises is followed by a gradual achievement of full range-of-motion. Gradually, stretching/ strengthening exercises are introduced as tolerated

Grade 2 sprain: Partial tearing of the ligament. Abnormal looseness of the ankle joint occurs when moved in specific directions.

Treatment proceeds more cautiously than with a grade I sprain. The ankle is immobilized in a splint, or walking boot for 1-2 weeks. Gradual weaning away from use of the splint is begun as swelling, bruising and pain subside and full active ROM is attained. Isometric exercises are followed by resistance training of the muscles that will now need to provide more support to the ankle in the absence of the full ligament integrity.

Grade 3 sprain: Complete tear of the ligament. If the ankle is pulled or pushed upon, gross instability is evident.

This type of sprain often requires confirmation that no fracture is present. Dependent upon joint stability and the extent of injury, this level of injury may require surgical intervention to stabilize the joint.

Non surgical post injury interventions are initially designed to address pain management, elimination of edema and gradual introduction of range of motion. The ankle is often kept non weight bearing and immobilized in a rigid support for several weeks. Rehabilitation after an ankle sprain injury of this severity will take several weeks and, in a few cases, several months. A physical therapist has the knowledge and skill to design a graduated, progressive program designed to restore strength and range of motion so you can return to pre-injury function. Physical therapy interventions are initially non weight bearing and may include water exercises until weight bearing is tolerated. Proprioception training is introduced, as poor propriception is a major cause of repeat sprain and an unstable ankle joint. Resisted exercises for strength gains are introduced and progression to more complex exercises, such as agility and balance drills, are added as strength improves.

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