Ankle Sprain

By Quiana Roberts, PT, DPT

A ligament sprain of the ankle is defined as severe stress, stretch, or tear of one or more ligaments. The ligaments at the outside of the ankle are sprained more often than the ligaments at the inside of the ankle. These ligaments may be sprained when the foot is turned or twisted too far, when the foot is planted awkwardly during stepping or running, or when an unusual amount of force is applied to the ankle.

The ankle has ligaments at the medial (inner) and lateral (outer) sides. The ligaments connect the tibia and fibula, bones of the lower leg, to the talus and calcaneous, bones in the foot. When healthy, ligaments help maintain stability in the ankle by holding the bones together.

A ligament sprain is defined as a stretching and tearing of ligament fibers from sudden or violent stress. A sprain is graded by the degree of the tear. A grade 1 sprain indicates tearing of a few fibers leading to pain and minimal swelling. A grade 2 sprain indicates stretching and tearing of a more significant number of fibers resulting in intense pain and significant swelling. A grade 3 sprain indicates rupture of the ligament and surgery may be necessary to restore stability.

Following an ankle sprain, an individual may experience pain, swelling, increased joint mobility, and tenderness to the touch. Ice and elevation are important during the first couple of hours to days after an ankle sprain. If pain and swelling persist and walking more than a few steps is intolerable 5-7 days following injury, medical treatment may be necessary.

Physical therapy treatment includes various techniques that address impairments. Cross friction massage and modalities like electric stimulation and ultrasound are used to promote healing, reduce pain, and control inflammation. Cautious, progressive manual and active stretching is performed to increase tissue flexibility without inhibiting the healing process. Therapeutic exercise is performed to develop muscle strength and reinforce stabilization of ankle while ligaments are healing.

The majority of people who have suffered acute or chronic ankle sprains are treated successfully with physical therapy and/or temporary avoidance of repetitive or strenuous activity. Typically, symptoms subside within 6-8 weeks depending on the severity of the sprain. If symptoms do not improve within 2-3 months, further diagnostic testing may be performed to rule out presence of Achilles tendon involvement or injury to bone.