Believe it or not ankle sprains are a very common injury. If you really think about it, you need to walk, run or jog in order to get anywhere. Because of this, there is a higher risk of getting an ankle sprain. Current research indicates that there are thousands of ankle sprains per day. Ankle sprains can be minor or severe but both can require physical therapy intervention. Physical therapy is often prescribed to patients with minor and even severe ankle sprains. Ankle sprains are broken down into high-level ankle sprains and low-level ankle sprains.
High-Level Ankle Sprain
A high ankle sprain is also referred to as a syndesmotic ankle injury. A syndesmotic ankle sprain basically affects the front and back ligaments that hold fibula and tibia. These ligaments are higher up above the ankle. In my experience, this usually occurs in high-level athletes but it can happen to anyone. It is the harder of the two to occur because of the nature of forces required to sustain the injury. The foot needs to go into an extreme external rotation which will put increased stress on these ligaments. Extreme external rotation is not an easy motion to achieve and that is why this type of ankle sprain is less common. Thankfully this is less common because they take longer to heal and can require bracing. Bracing decreases stress on the injured ligaments allowing for them to heal without stress.
Low-Level Ankle Sprain
A low-level ankle sprain or lateral ankle sprain is much easier to acquire. The ankle has much more of a chance of turning inward or rolling as you walk or run. The ligament most commonly affected is the A.T.F.L. That stands for Anterior TaloFibular Ligament which is also the weakest of those lateral ligaments. Most of the time you see some swelling on the outside aspect of the ankle after this occurs. In addition to swelling, it is common to have ankle pain, reduced range of motion, and strength/balance issues after both types of sprains.
What do you do?
The first thing you should do is perform R.I.C.E. during the initial 48 hour period. This stands for Rest, Ice, Compression, and Elevation. After the first two days, you should go see a physical therapist in order to get treatment started. The Physical Therapist will take you through an initial exam in order to determine base line strength, a range of motion, and swelling/pain levels. If the physical therapist determines that an x-ray or MRI is required they can refer you to a medical doctor. Most of the time ankle sprains can be treated without an X-Ray or MRI to start.
A typical physical therapy treatment session will consist of modalities such as electrical stimulation, ultrasound, and hot/cold pack therapy. You should also get some hands on therapeutic massage and ankle joint mobilizations. This manual therapy will help decrease swelling and pain in addition to helping increase AROM/PROM. Finally, your sessions should involve some simple exercises for the ankle joint. The therapeutic exercises are excellent to increase ankle range of motion and strength. Exercises will also be helpful to increase balance. The ligaments in the ankle play a key role with balance so when a sprain occurs usually poor balance follows. The general course of physical therapy treatment will be 4-6 weeks at 2-3 sessions per week.
This type of injury reacts well to physical therapy treatment when there aren’t actual tears on the ligaments. One unfortunate fact regarding ankle sprains is that once you get one, chances are you can and will get another one. The ligaments stretched with your current sprain never get back to the initial shortened length. Hence, on a biomechanical level that sprained ankle is now at high risk for reoccurrence.