Lateral ankle sprains (sprains to the outside of the ankle) are a common occurrence in the active population. Prevalence of ankle sprains is approximately 7 out of 1000 people during a given year, and primarily occurs during sporting activities (45%). Lateral ankle sprains account for 60% of ankle sprains. The lateral ankle is vulnerable during plantar flexion and inversion ‘rolls’ of the ankle (when you roll on the outside of the ankle with the toes pointed down). The primary lateral ankle ligaments are the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). Depending on the severity of the ankle sprain, one or more of the ligaments are affected. A grade I sprain consists of mild pain, minimal bruising/swelling, and typically affects the ATFL. A grade II sprain consists of moderate pain and bruising/swelling, and involves both the ATFL and CFL. A grade III sprain consists of severe pain and bruising/swelling, involves all three ligaments, and commonly involves an ankle fracture too. 71.3% of lateral ankle sprains are considered grade I, followed by 9.5% and 2.9% for grade II and III sprains, respectively.
Grade I sprains initially call for R.I.C.E (rest, ice, compression, elevation), along with early range of motion exercises, and weight bearing on the affected leg. If the patient is forced to limp, the use of an assistive device (such as cane or crutch) can help normalize a gait pattern. The majority of patients with a grade I ankle sprain improve within 2-4 weeks, and can be simply progressed back to normal activities by a skilled physical therapist. Depending on the extent of injury and results of the evaluation from your physical therapist, various treatment strategies may consist of cross-friction mobilization to the affected ligaments and/or muscles or tendons, progressive strengthening exercises, stretching, and functional retraining of the ankle and leg to help prevent future recurrence of injury.
Frequently, there is noted stiffness into dorsiflexion (in weight bearing, dorsiflexion is the ability to bring the knee in front of the ankle, when the foot is planted on the ground (i.e. calf stretch with the knee bent)) in patients with lateral ankle sprains. The patient commonly complains of anterior (front of the ankle) pain when going downstairs, when squatting, and/or during incline walking or running. The reason for this stiffness, which can persist long after an ankle sprain, involves the talocrural (ankle) joint and is secondary to what happens to the ankle joint during a lateral ankle sprain.
The talocrural (ankle) joint is a hinge joint that brings the foot up into dorsiflexion and down into plantarflexion (going up on toes). It consists of the distal portion of the lower leg (the end of the tibia and fibula) and its articulation with the talus (the ankle bone). The up and down motion of the ankle goes along with a slight rotation at the talus. As your foot comes up into dorsiflexion, your talus and foot rotates out. As your foot comes down into plantarflexion, your foot rotates in as your talus internally rotates. During dorsiflexion, the front portion of the talus (which, anatomically, is wider anteriorly) comes into contact with the lower leg bones and must fit between those two bones. With lateral ankle sprains, as the ankle is plantarflexed and inverted, the talus can become stiff into the opposing motion of dorsiflexion. Your physical therapist will evaluate the joint mobility of the ankle, and if limited, will look to improve the mobility through mobilization, manipulation, muscle energy, and/or prolonged low-load stretching. It is the author’s opinion that talocrural stiffness into dorsiflexion is commonly found in patients after lateral ankle sprains, and that patients who are appropriate for manipulation respond favorably to manual therapy, including manipulation, geared at improving this range of motion.
At Life’s Work Physical Therapy, every therapist is trained in proper evaluation and treatment of patients with ankle sprains. Our evaluation skills help us to determine what structures have been injured, and what other impairments are involved. Treatment is individually delivered to meet the needs of each patient, with their activity goals in mind to help drive functional retraining of the lower quadrant once the initial injury begins to improve.
If you recently have sustained a lateral ankle sprain, or have not returned back to full function after an ankle sprain, contact Life’s Work Physical Therapy today. We look forward to getting you on the right path towards recovery!