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Physical Therapy

Ankle Sprains

October 5, 2020
By Health Loft

What can your Physical Therapist do for you

Every year, millions of Americans take part in a wide range of sports such as soccer, football, and basketball as well as activities like hiking, gardening, jogging, and walking. You’re probably wondering, what do sports and activities all have in common? All of them require stability from our ankles.

Your ankles, as you may have guessed, are vital to efficient performance of all upright activities. Your ankle is also complex, as its purpose is to not only provide the mobility to accommodate different surfaces, but also provide enough stability to keep you from falling! Although most of the time the ankle is able to perform its job admirably, sometimes we overload the structures meant to provide stability. This leads to one of the most common injuries that we as physical therapists see everyday: An ankle sprain.

Although a majority of ankle sprains are minor, and do not require medical treatment, some sources believe > 20,000 individuals a day require some form of medical treatment for an ankle sprain. The majority of these cases come from individuals playing recreational sports. As a physical therapist, it is our job to get these individuals back to their day-to-day activities, as well as competing in their chosen recreational activities.

 

What is an ankle sprain?

All of the joints in our body consist of three structures: bones, ligaments, and tendons. When discussing ankle sprains specifically, we are mostly concerned about ligaments. A ligament is a thick, fibrous band of tissue meant to keep your joints nice and stable as it moves. A ligament sprain occurs when the forces placed upon the tissue are greater than the force that tissue can sustain before “giving out.”

All ligament sprains are not created equal, and many factors can affect the severity of a tissue injury. In order to classify these injuries effectively, ligamentous sprains are identified using a 3-tiered grade based system. 

A grade I ankle sprain is the least severe of the 3-tier classifications. In a grade I ankle sprain, there is only damage to the tissue on a cellular level, but no tearing of the tissue that could lead to instability. However, tenderness in the region affected is common. 

A grade II sprain occurs when physical tearing occurs in the ligament in question. However, it is only a partial tear as opposed to a full thickness tear (which would mean the entire ligament is torn). In this situation, pain and inflammation in the region are common, as well as some instability within the joint. At this classification level, surgery may not be necessary, and proper rehabilitation including rest, icing, and physical therapy can be effective in returning a person back to their preferred activities. 

A grade III sprain is the most severe injury of the 3-tier classification. In this scenario, there is a complete tear of the ligament in question, and severe instability can be present in the joint. Inflammation is common as well as pain, however these injuries can sometimes be less painful due to the complete laceration of the tissues. Treatment wise, research shows that physical therapy without surgery can sometimes return a patient to their previous level of activity in select cases. However, in many cases surgery is required for full return to sport, with both pre and post rehabilitation vital to a patient’s recovery.

While there are many ligaments across your ankle joint that are important for stability, the three main ligaments we will focus on will be the Anterior Talo-Fibular Ligament (ATFL), the Calcaneal-Fibular Ligament (CFL), and the Deltoid ligament.

The most common type of ankle sprain is a lateral ankle sprain, in which a patient’s ankle will go into extreme plantar flexion and inversion (down and in direction). In this scenario, the ATFL and CFL are the structures most susceptible to damage. This can result in pain and inflammation in the frontal/lateral part of your ankle, as well as some instability into inversion (inward direction).

Another type of ankle sprain that is less common is a medial ankle sprain; in which the Deltoid ligament is affected. In this case, an injury occurs when a patient’s ankle goes into extreme eversion and dorsiflexion (out and up direction). This can lead to instability, pain, and inflammation in the inside of your ankle.

 

Physical Therapy Interventions for Ankle Sprains In Chicago

Regardless of which type of ankle sprain you have, you can be assured that your Heath Loft physical therapist in Chicago  can help. After your physical therapist performs a thorough evaluation and examination, they will create a detailed and personal rehabilitation plan for you in order to help you achieve your goals. A good physical therapy program will focus on strengthening your musculature, improving your range of motion, and improving your ability to balance on your ankle.

 

Ankle Strengthening

Strength training is an integral part of rehabilitation following an ankle sprain. After an injury, the structures that are damaged can become weak after periods of immobilization or non-use. Strength training is important to build up both the strength of the muscles surrounding the ankle to perform both movement, as well as to prevent unwanted movement and create ankle stability.

Common strengthening exercises physical therapists will use involve the use of elastic bands. Under the instruction of your physical therapist, the band will be placed on your forefoot in a way to resist a certain motion that your therapist wishes to strengthen. Generally, your therapist will want to strengthen the major movements of the ankle: Inversion (inward), Eversion (outward), Dorsiflexion (upward) and Plantarflexion (downward). These are some of the simplest exercises your physical therapist can have you perform, and are characterized as open-kinetic chain exercises. They can even be performed without a band in the early phases of recovery.  See below for additional information on introductory exercises.

  • Ankle Inversion with theraband – 3 sets, 12 repetitions
  • Ankle Eversion with theraband – 3 sets, 12 repetitions
  • Ankle Dorsiflexion with theraband – 3 sets, 12 repetitions
  • Ankle PlantarFlexion with theraband – 3 sets, 12 repetitions 

Once  you progress past the phase of open-kinetic training, you will be moved on to closed-kinetic chain exercise(where your foot will have contact with a stable surface such as the floor). Ankle heel raises and toe raises are common examples of these exercises that work to strengthen the calf and muscles in the front of the ankle.

  • Heel Raises – 3 sets, 12 repetitions
  • Toe Raises – 3 sets, 12 repetitions

As these are just examples of exercises that are commonly prescribed in the beginning of your rehab journey, rest assured your physical therapist will provide you with more complex and challenging ankle strengthening exercises as you progress through your ankle sprain treatment program.

 

Ankle Range of Motion and Flexibility

Adequate range of motion at the ankle is vital for proper function of the ankle joint. After an injury, the structure and tissues of the ankle will shorten and become tight in order to protect the joint from further damage. However, structures that are too tight are unable to perform their role correctly for when you become active again. 

 

Stretching:

One way in which your physical therapist will help you to improve your range of motion at the ankle will be by instructing you in various stretches. Stretching can be performed manually by your therapist, but you will also be instructed in a self-stretching program to perform at home. These stretches will not only target your ankle specifically, but will also focus on stretching the entire leg musculature as well in order to provide your lower limb with the flexibility it needs to perform day to day activities. Common stretching techniques will target the muscles on the inside and outside of your ankle, your calf muscles, as well as the quadriceps and hamstring muscles of your thigh.  See below for examples on different stretches for your ankle. 

  • Ankle Circles –  – 3 sets, 15 repetitions 
  • Calf Stretch (knee straight) – 3 sets, 30 second holds
  • Calf Stretch (knee bent)  – 3 sets, 30 second holds
  • Hamstring Stretch – 3 sets, 30 second holds
  • Hip Flexor/Lunge Stretch – 3 sets, 30 second holds

 

Manual Therapy:

Manual Therapy can also be performed by your physical therapist to help improve the range of motion and flexibility of your ankle. Common forms of manual therapy include joint mobilizations and massage.  Joint mobilizations focus on improving the flexibility of your ankle joint capsule by elongating said structures in a safe manner. Massage is also used by physical therapists to improve tissue function and flexibility. Massage helps to relax muscles, allowing them to move more freely and respond to exercise more effectively.

Other modalities such as heat pads, ice packs, electrical stimulation, dry needling, and ultrasound may be used by your physical therapist to further help with tissue flexibility and relaxation. However, these only serve as adjuncts to physical therapy, and shouldn’t be performed in isolation. 

 

Ankle Balance exercises

Finally, balance exercises can be seen as the final and most crucial intervention in order to return athletes to sport and individuals back to their everyday activities. The reason why balance is so crucial is that we spend much of our time throughout the day balancing on one leg. Even normal walking requires constant single leg balance, as 60% of our gait cycle is spent on one leg.  As previously mentioned, strength and flexibility at the ankle joint are extremely important towards stability, which in turn make them vital for balance. However, there is a third detail that is extremely important to balance, which is called proprioception. Proprioception is basically a sensation your body uses in order to sense “where it is in space “without looking. The ability to sense where you are without looking is vital, as we generally don’t look at our feet all day while we walk and participate in other activities.

The ways in which you can train your single leg balance is only limited by a therapist’s imagination; however, there are a few mainstays that you most likely will encounter in your rehabilitation. First is the most simple; simply standing on one leg. This directly trains your ankle’s ability to attenuate to different forces that require balance, and your therapist will instruct you on the time and duration of each hold. As you get better, your therapist will increase the hold time.

As you begin to master standing on one leg, you will progress to different varieties of single leg balance exercises such as on an unstable surface, on narrow, or on broad surfaces.  Some physical therapists will even have you walk on sand.

Once you have advanced through simple balance exercises your physical therapist can initiate dual-task training. This basically means that your therapist will have you perform a variety of activities while simultaneously balancing on one leg. This can include cone stacking, having a catch with a ball, standing with your eyes open or closed, and endless other possibilities. 

Eventually you will progress to even more complicated activities such as jogging, sprinting, hopping and more sports specific or hobby specific activities to ensure that you are ready to return to your activities of choice.

Sustaining an injury such as an ankle sprain, regardless of severity, can have a large impact on your life.  Consult with one of our physical therapists in Chicago (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. If you have further questions regarding dry needling, we would also be happy to answer them.  Remember to also check out our FacebookInstagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!

 

Written by Brian Connell
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES

 

REFERENCES

  1. Ankle Sprain. (n.d.). Retrieved from https://www.physio-pedia.com/Ankle_Sprain
  2. Czujko, P.-N. (2017). Orthopedic Management of the Foot and AnkleOrthopedic Management of the Foot and Ankle. Stony Brook.
  3. Mattacola, C. G., & Dwyer, M. K. (2002, December). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164373/
  4. Los Amigos Research and Education Institute, Rancho Los Amigos National Rehabilitation Center. (2001). Observational gait analysis. Downey, CA.
  5. Sprained ankle. (2018, November 28). Retrieved from https://www.mayoclinic.org/diseases-conditions/sprained-ankle/symptoms-causes/syc-20353225
  6. What is the prevalence of ankle sprains? (2019, November 10). Retrieved from https://www.medscape.com/answers/1907229-95137/what-is-the-prevalence-of-ankle-sprains
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