This is a very common sporting and accidental injury which typically occurs when ‘rolling your ankle’ or ‘going over’ on it. This mechanism in which the foot folds under and your leg goes sideways causes damage to the ligaments on the outside region of the ankle – typically the anterior talo-fibular ligament (ATFL) and/or the calcaneo-fibular ligament (CFL).
A lateral ankle sprain (ALS) is usually graded on a scale of 1-3. A grade 1 injury is categorised as damage at a microscopic level without a stretch. Presentation usually involves minimal swelling and soreness and functional capacity being maintained. A grade 2 represents a tearing of the ligament but remains attached – this presents with a degree of swelling and pain coupled with reduced function and movement alongside instability. Finally, a grade 3 entails a complete rupture of the ligament and involves significant swelling, severe tenderness, reduced stability and functional loss.
Total rest and immobilisation is usually advised, however, at Pure Physiotherapy, we recommended the use of functional support – such as a brace, which has shown to produce better functional outcomes than immobilisation during the early phase following trauma.
Exercise therapy forms the foundation of the treatment and recovery following an LAS. The goals in early rehabilitation are to manage the swelling and work towards achieving full range of motion; beginning with gentle movement to maintain range and then gradually developing the movement. Alongside range of motion exercises, isometric holds can begin. See below a couple of exercise Pure Physiotherapy recommends.
When >80% of range has been achieved, we can begin to strengthen through this available movement. This can be done using resistance bands and/or progressive weight bearing exercises. We are looking to strengthen pointing and bending the ankle and lateral movements – most specifically the movement which is opposite to the mechanism of injury which is called eversion. Stability exercise is also recommended – single leg balance whilst reaching out with the other leg in various directions is a key exercise to implement. Imaging being stood in the middle of a clock face standing on one leg and then reaching out to touch the numbers with the leg that is off the floor. The video below demonstrates the calf raise exercise which can help the transition with partial and full weight-bearing strength work
As range of motion improves and pain reduces, aim to walk as symmetrical as tolerable alongside progressively introducing more load/weight-bearing activity. Going forward, as strength, function and movement improves, exercises are required to be progressively increased in resistance and complexity in line with symptoms before returning to activity/sport.