Physiotherapy management for ankle sprains - what to we do?

Ankle Sprains: The role of physiotherapy and rehabilitation for a better recovery.  What does the scientific evidence tell us?

 

Ankle sprains are a very common physical injury.  They are prevalent in running sports but can also occur in the home, community or workplace.  Many dismiss sprains as simple injuries that will recover on their own, however there is scientific evidence to show that physiotherapy and rehabilitation can improve your recovery and reduce your risk of ongoing problems. This is particularly important because anywhere between 3-34% of people will re-sprain their ankle again and 5-33% of people will still experience ankle pain one year after injury (Van Rijn et al. 2008)

The term “ankle sprain” is a generic term used to describe any ligamentous injury of the ankle.  The most common ligamentous injuries occur to the ligaments that form the lateral ligament complex.  An injury to one or more of these ligaments is known as a “lateral ligament injury”.  There are many other soft tissue injuries that can occur around the ankle but for the purpose of this article, we will discuss lateral ligament injuries.

There are 3 ligaments that form the lateral ligament complex: the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL).  They are shown below in Figure 1 with the ATFL and CFL circled, as they are most commonly injured.  This occurs when a person rolls their ankle in an inwards direction, otherwise known as an inversion sprain.

Fig 1.  The lateral ligament complex of the ankle

Fig 1.  The lateral ligament complex of the ankle

After an inversion injury has taken place it will need to be diagnosed accurately.  A thorough clinical examination will need to occur to rule out any other serious injuries, as these may require other forms of treatment.  X-Rays can be ordered to rule out a bone fracture.  If a diagnosis of a lateral ligament injury has been made, there are measures that can be taken to optimize recovery, which is backed by evidence.

Rest, ice, compression and elevation (RICE) should occur in the first 3-5 days after injury. According to Bleakley et al (2004), an initial period of icing followed by a course of exercise is very effective.  It was also noted that ice should be applied for less that 20 minutes because longer application can increase the risk of ice burning and nerve damage.

The next stage of recovery is the rehabilitation phase.  This is needed to address the tightness, muscle weakness and ligament laxity caused by injury.  A physiotherapy-guided progressive balance and proprioception retraining program using a balance platform or wobble-board over a 12 week period will result in significantly improved ankle stability and proprioception (Lee and Lin, 2008) (Fig 2).

Fig 2.  Use of a wobble board for balance and ankle proprioception retraining (Image sourced from www.sportsinjuryclinic.net)

Fig 2.  Use of a wobble board for balance and ankle proprioception retraining

(Image sourced from www.sportsinjuryclinic.net)

When returning to sport after an ankle injury, ankle taping or wearing an ankle brace reduces the risk of re-injury (Handoll et al. 2001).

In conclusion, a lateral ligament sprain needs to be diagnosed accurately with a detailed clinical examination (with or without imaging), treated initially with RICE and followed by a structured physiotherapy rehabilitation program focusing on balance and proprioception retraining and return to sport activities.  Ankle braces and taping are preventative measure against re-injury when returning to sport.  If you are having issues related to an ankle sprain speak to a physiotherapist today.


Daniel Di Mauro is a McKenzie credentialed physiotherapist working at Advance Healthcare in St Albans. Daniel has a special interest in treatment of low back pain, and is heavily involved in our multidisciplinary pain management programs.  Daniel provides expert physiotherapy services to nearby areas such at Keilor, Sunshine and Patterson Lakes. For more on Daniel, see our practitioner listing


References:

van Rijn, RM. van Os, AG. Bernsen, RM. Luijsterburg, PA. Koes, BW. Bierma-Zeinstra, SM. (2008). What is the clinical course of acute ankle sprains? A systematic literature review. The American Journal of Medicine. 121(4): 324-331

Bleakley, C. McDonough, S. MacAuley, D. (2004). The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trails. American Journal of Sports Medicine, 32(1): 251-61

Lee, AJ. Lin, WH. (2008). Twelve-week biomechanical platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clinical Biomechanics (Bristol, Avon). 23(3): 1065-72

Handoll, HH. Rowe, BH. Quinn, KM. de Bie, R. (2001). Interventions for preventing ankle ligament injuries. Cochrane database of systematic reviews. (3): CD000018