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 (LAS) 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.
Based on the mechanism of injury, symptom severity and clinical presentation when seen in clinic, your Physiotherapist will have the knowledge and experience to provide you with an accurate and timely diagnosis which will ensure the most effective treatment and management plan is put in place.
Your clinician will give you information on which grade of sprain you have sustained. Guided by your physical capability and what activities are important to you, we will work collaboratively with you to design a bespoke and progressive exercise and management programme, focused on your goals.
Your Physiotherapist will provide you with tips on how to take care of your injury in the early stages using the P.E.A.C.E protocol – protect, elevation, avoid anti-inflammatories, apply compression and education how to manage your injury. In the early stages, total rest and immobilisation is usually advised, however, we recommend 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 rehabilitation forms the foundation of the treatment and recovery following LAS. The goals in the early stages of 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.
Throughout your treatment, your progress will be monitored with regular re-assessment. 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 of the ankle and lateral movements – most specifically the movement which is opposite to the mechanism of injury which is called eversion.
As range of motion improves and pain reduces, your Physiotherapist will implement goals for restoring a normal walking pattern which is as symmetrical as tolerable, alongside progressively introducing more load/weight-bearing activity. As your are re-assessed, your strength, function and movement will improve. Your exercises will be progressed using increased resistance and complexity – in line with symptoms, before returning to the activity(ies)/sport that is important to you.
Please find the patient resources section of our website where we have created a series of recommended exercise programmes for LAS. We advise consulting with your Physiotherapist prior to trying any of these exercises.
Your Physiotherapist at Pure may use soft tissue mobilisation and manual therapy techniques to help support your recovery by reducing pain and increasing the movement available. We also aim to provide you with the skills and knowledge to manage your injury autonomously through ongoing advice and support so that you can prevent re-occurrence.
In cases where symptoms and functional limitations are severe, your Physiotherapist may consider an onward referral. This discussion will take place if there is a raised suspicion of a fracture, nerve or blood vessel damage or a tendon rupture. Also, following a review 5-7 days later symptoms worsen or fail to improve, your Physiotherapist may consider further investigations to ensure your injury is managed safely and effectively. Onward referral may comprise of being sent for an X-ray or MRI, an Orthopaedic opinion or to the emergency department. All of these options will be discussed and agreed with you at the center of the decisions being made.
NHS information on sprains and strains – click here.
National Institute of Health and Care Excellence. (2020). The management of sprains and strains in primary care. Retrieved from https://cks.nice.org.uk/sprains-and-strains#!scenario [Accessed 6/7/2020].