What Is Ankle Sprain?
Sprains are injuries to ligaments, the “bands” that hold joints together. Ankle sprains occur when the foot twists or turns beyond its normal range of movement, causing the ligaments to stretch beyond their normal length. If the force is too strong, the ligaments may tear.
An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged or how many ligaments are injured. An ankle sprain is given a grade from 1 to 3 depending on the amount of ligament damaged. A grade 1 sprain is mild, grade 2 is moderate, and grade 3 is severe.
Ankle sprains also are classified as acute, chronic, or recurrent:
An acute sprain occurred recently—usually within the past few weeks—and is in an active stage of healing.
A chronic sprain continues to cause symptoms beyond the expected time for normal healing.
A recurrent sprain occurs easily and frequently, usually with only minimal force.
How Does it Feel?
With acute ankle sprain, you may have:
Inability to bear weight on the ankle
With most sprains, you feel pain right away at the site of the ligament tear. Often the ankle starts to swell immediately and may bruise. The ankle area usually is tender to the touch and, when you move the ankle, it hurts.
In more severe sprains, you may hear or feel something tear, along with a “pop” or “snap.” You probably have extreme pain at first and are not able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is, and the longer it will take to heal.
How Is It Diagnosed?
Your physical therapist can perform a full evaluation. Manual tests are used to determine how unstable your ankle is. The therapist also will decide whether further tests are required or whether consultation with another health care provider is necessary. In some cases, x-rays might be needed to determine whether there is a broken bone. Occasionally, with severe sprains, magnetic resonance imaging (MRI) might be ordered to determine the extent of the damage.
How Can a Physical Therapist Help?
The First 24 to 48 Hours
For the first 24 to 48 hours after injury, ankle sprains usually are treated by resting the ankle on a pillow or stool, using elastic bandages or supports, and 10-minute ice treatments. A physical therapist can decide if you should use crutches or a cane to protect your ankle while it is healing.
The therapist can design a specific treatment program for you to follow at home to help speed your recovery. Some sprains may require physical therapy treatments to help relieve swelling and pain, such skilled hand movements called manual therapy, special exercises, ice or heat treatments, and electrical stimulation. More severe sprains may require a special brace to provide extra support to your ankle.
As You Start to Recover
Your physical therapist’s overall goal is to return you to the roles you perform in the home, at work, and in the community. Without proper rehabilitation, serious problems—such as decreased movement, chronic pain, swelling, and joint instability—could arise, severely limiting your ability to do your usual activities.
Your physical therapist will select from treatments including:
Range-of-motion exercises. Swelling and pain can result in limited mobility of the ankle. A physical therapist teaches you how to do safe and effective exercises to restore full movement to your ankle.
Muscle-strengthening exercises. Ankle muscle weakness may cause long-term instability of the ankle and new ankle injuries. Your physical therapist can determine which strengthening exercises are right for you based on the severity of your injury and where you are in your recovery.
Body awareness and balance training. Specialized training exercises help your muscles “learn” to respond to changes in your environment, such as uneven or unstable surfaces. When you are able to put full weight on your foot without pain, your physical therapist may prescribe these exercises to help you return to your normal activities. For instance, your physical therapist might teach you how to do this: with or without your eyes closed, stand on one leg or stand on a wobble board to challenge the muscles around your ankle.
Functional training. When you can walk freely without pain, your physical therapist may begin “progressing” your treatment program to include activities that you were doing before your injury, such as walking in your neighborhood, jogging, hopping, or modified running. This program will be based on the physical therapist’s examination of your ankle, on your goals, and on your activity level and general health.
Activity-specific training. Depending on the requirements of your job or the type of sports you play, you might need additional rehabilitation that is tailored for your job or sport and the demands that it places on your ankle. Your physical therapist can develop a program that takes all of these demands—as well as your specific injury—into account.
Can this Injury or Condition be Prevented?
If you have sprained your ankle more than once in your life, you might be at risk for re-injury in the future if the ligaments did not heal properly or if your ankle never returned to its normal strength. And, if you returned to sports or activities too soon after injury, your ankle might give you persistent pain or might easily or frequently sprain. A physical therapist determines when you are ready to return to your activities and sports and helps make sure that your ankle is strong and ready for action, using body awareness and balance training, exercises to correct imbalances and weakness of specific muscles, exercises to improve mobility, and a progressive functional training program that allows you to gradually and safely return to your activities without injury.
Real Life Experiences
You’re in a hurry but need to stop to pick up something from the store on your way home. While you rush out of the store, you don’t notice the curb and twist your ankle. You don’t fall, but you immediately have some pain in your ankle. By the time you get home, your ankle still hurts, and you think it might be starting to swell a little.
What do you do next?
Immediate first aid for an ankle injury includes “RICE”:
If you are unable to walk without pain, you might need crutches or another type of assistance. Your physical therapist will perform a full examination of your ankle to determine whether additional tests or referral to another health care provider is necessary. In most cases of ankle sprain, the therapist will manage your care through your full recovery.