It is not intended to substitute clinical judgment regarding the patients post injury care, based on exam treatment findings, individual progress, andor the presence of concomitant injuries or complications. Ankle sprain can injure the medial ligaments, lateral ligaments, or the. Rehabilitation of syndesmotic high ankle sprains glenn n. May 28, 20 interestingly, malliaropoulos found that lowgrade acute lateral ankle sprains result in a higher risk of reinjury than highgrade acute lateral ankle sprains. Functional outcomes and psychological benefits of active. The average general orthopaedic surgeon examines and treats a considerable number of acute lateral ankle ligament sprains in a busy office practice. The effectiveness of deep oscillation therapy on reducing. Ankle sprain rehabilitation guideline sanford health. Apr 08, 2015 surgical repair of ruptured ankle ligaments is sometimes considered in patients with ankle sprains. Respectively, these injuries are referred as medial, lateral or high ankle sprains. Ankle sprain involves stretching or tearing of the ligaments of the ankle.
The high rate of failure after ankle sprain treatment might be explained by overlooked associated lesions, such as. Diagnosis, treatment and prevention of ankle sprains. For indoor sports, an incidence of 7 las per exposures has been reported. Most ankle sprains involve the ligaments on the lateral outside aspect of the ankle. She sustained an inversion injury to her left ankle while descending from a stool. Download fulltext pdf physiotherapy for patients with lateral ankle sprains article pdf available in physiotherapy 849. Functional anatomy and biomechanics of the sporting ankle. Diagnosis and therapy starts with knowledge of anatomy written by pau golano, spain and jordi vega, switzerland. It is usually a result of a forced plantarflexioninversion movement, the complex of ligaments on the lateral side of the ankle is torn by varying degrees. In the ankle joint, ligaments provide stability by limiting sidetoside movement. You can use surgical tubing, theraband, or a bike inner tube for the resistance.
The patient was a 49yearold woman working as a surgical technologist. Three randomized control trials were located and appraised. Ankle sprain can injure the medial ligaments, lateral ligaments, or the syndesmotic tibiofibular joint. Decreaseeliminate pain, increase rom, decrease swelling, increase strength continue pain and swelling management. Lateral ankle sprains are a common injury with an estimated occurrence rate of 23 000 per day in the usa. The guidelines provided for the treatment of ankle sprains are of general validity, but each athlete is. Injury to the ankle joint is the most common peripheral joint injury. The common mechanism of injury is inversion with excessive ankle supination in forced plantarflexion when the ankle joint is.
It is estimated that one inversion injury of the ankle. The greatest risk for an inversion ankle sprain is a history of a previous sprain. Clinical assessment of acute lateral ankle sprain injuries. Lateral ankle sprains occur more than any other musculoskeletal injury in an athletic population. Pdf lateral ankle sprain and chronic ankle instability. Modified brostromgould repair for chronic lateral ankle. Ankle sprain rehabilitation the following protocol is designed to strengthen and increase the flexibility of the muscles surrounding the ankle, which should decrease the chances of incurring another ankle sprain. Rehabilitation of the ankle after acute sprain or chronic. Eccentric reinforcement of the ankle evertor muscles after lateral ankle sprain h. On the lateral portion of the ankle there are three ligaments which. Rehabilitation of syndesmotic high ankle sprains glenn. C compression place an ice bag on the ankle for 15 to 20. Pdf physiotherapy for patients with lateral ankle sprains. A minor sprain usually keeps an athlete out of competition for several days to 2 weeks, and a moderate sprain usually keeps an athlete out of competition for 2 to 4 weeks.
Lateral ankle sprains are thought to be suffered by men and women at approximately the same rates. Comparison of conventional treatment and supervised. Ankle injuries are a common cause of morbidity in the general and athletic population, with an estimated 25,000 ankle sprains requiring medical care in the united states per day. Navy active duty service member that was initially diagnosed with a lateral ankle sprain. Clinical research studies report that surgery had good results in patients. Comparison of conventional treatment and supervised rehabilitation for treatment of acute lateral ankle sprains. E elevation wrap an elastic bandage from the toes to mid calf, using even pressure.
Supervised physiotherapy for mild or moderate ankle sprain. A lateral ankle sprain las is a frequently incurred musculoskeletal injury, with a high prevalence among the general population and individuals who participate. Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. It should however be noted that approximately 75% of ankle sprains are actually a reoccurrence of a previous sprain.
Besides management of the common inversion sprain, conditions such as severe sprains see pp 28, deltoid sprains see pp 29, high ankle sprains see pp 30, and chronic ankle pain or instability see pp 35, require additional consideration. An ankle sprain occurs when a ligament connecting the ankle bones is stretched or torn. Delayed conservative treatment of an acute lateral ankle. Sports ankle injuries assessment and management pdf. Reports indicate that up to 73% of people who sustain a lateral ankle sprain have recurrent sprains, but it is unknown how many of these participants partake in rehabilitation. This can be caused by a fall, a sudden twist, or landing on the side of the foot. The acute group consisted of 15 consecutive patients who had sustained a grade i1 inver sion ankle sprain within 3 weeks prior to isokinetic testing and who. Plyometric training versus resistive exercises after acute lateral ankle sprain.
Treating a sprained ankle can help prevent ongoing ankle problems. It is particularly important in the ankle joint where sprains are one of the most prevalent injuries of the musculoskeletal. Inversion sprain lateral ligament mechanism of injury. Although the ankle sprain is a relatively benign injury, inadequate rehabilitation can lead. Foot and ankle rehabilitation exercises to ensure that this program is safe and effective for you, it should be performed under your doctors supervision. A lateral ankle sprain las is a frequently incurred musculoskeletal injury, with a high prevalence among the general population and individuals who participate in sports. This course provides an overview of the clinical practice guideline for lateral inversionmechanism ankle sprains. The acute group consisted of 15 consecutive patients who had sustained a grade i1 inver sion ankle sprain. Rehabilitation involving exercises and strengthening to the ankle following injury will ensure full strength is regained in the ankle, and this will hopefully prevent reoccurrences. Treating lateral ankle sprain in basketball playersa.
Modifying current rehabilitation protocols to include protecting the ankle joint with stringent immobilization. Ankle complex injuries in sport sports rehabilitation. Ankle sprains are common injuries that can result in lifelong problems. Following initial injury, a high proportion of individuals develop longterm injuryassociated symptoms and chronic ankle instability. Rehabilitation of lateral ankle sprains in sports intechopen. A thorough knowledge of anatomy is imperative for adequate assessment of joint injury.
Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Modified brostromgould repair for chronic lateral ankle instability. The best exercises for strengthening an unstable ankle are oneleg balance exercises studies over the past ten years have demonstrated that these oneleg balance exercises are a critical part of rehabilitation after an ankle sprain or following a diagnosis of an unstable ankle. Athletes with moderate to severe lateral ankle ligament sprains should wear a semirigid or. Lateral ankle sprains have been shown to be one of the most common musculoskeletal injuries in both athletes and the recreationally active population. Prolonged immobilisation and delayed referral to physical therapy are associated with poorer outcomes. Lateral ankle ligament injuries are graded 1, 2, or 3 fig 2. This first course of the two course series on lateral ankle sprain, will discuss the differential diagnosis, risk factors, prognosis, and clinical measures for patient reported outcomes. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient who has undergone an anatomical surgical procedure. An ankle radiographic series is indicated if a patient has pain in the malleolar zone and any of these findings. Management of acute lateral ankle ligament injury in the athlete. Intrinsic and extrinsic risk factors for lateral ankle sprain. Recurring instability associated with subjective complaints of giving way is often termed chronic ankle instability cai. Eccentric reinforcement of the ankle evertor muscles after.
Lateral ankle sprains lass are among the most common injuries encountered during sport and exercise participation. Summary of key findings the literature was searched for studies of level 2 evidence or higher that investigated deep oscillation therapy on pain and inflammation in patients with lateral ankle sprains. For grade 3 lateral ankle sprains also mobilization should be started as soon as the pain permits 10. Rehab exercises for ankle sprain seattle podiatrist. I like to program it with 3 to 4 sets of 1530 seconds matching the individuals resistance. Finally, rehabilitation is an important part of the. Future research must explicitly report all details of administered exercisebased rehabilitation programs. Moreover, it is estimated that approximately 30% of people who incur a lateral ankle sprain will ssustain recurrent ankle sprains and experience symptoms of pain and instability that last 1 year. Exercisebased rehabilitation reduces the risk of reinjury following acute ankle sprain when compared with usual care alone. Keeping these muscles strong can relieve foot and ankle pain and prevent further injury.
Poor rehabilitation after an initial sprain increases. Simple exercises can be done using elastic to create resistance fig. These same exercises also are the most effective exercises to strengthen the arch of the foot. Loosen the wrap if your toes start to turn blue or feel cold. Ankle injuries are very common, specially sprained ankles. A n ankle sprain is an injury to one or more ligaments in the ankle, usually on the outside of the ankle. Clinical benefit might depend on the nature, intensity, and duration of treatment lateral ankle sprains are the most common musculoskeletal injuries in physically active populations. Rehabilitation after ankle sprain center for sports. Lateral ligament injuries are perhaps one of the most common sportsrelated injuries seen by physiotherapists. This guideline is intended to provide the treating clinician a frame of reference for rehabilitation.
The treatment and rehabilitation goals must also address restoration of neuromuscular function, as well as. These include 1 ice, 2 compression by wrapping the ankle tightly, 3 elevation by keeping the ankle up for example by propping it on pillows when lying down, and 4 overthecounter pain medications, such as ibuprofen, and can all decrease the uncomfortable symptoms of an ankle sprain. Functional instability following lateral ankle sprain. An ankle sprain is where one or more of the ligaments of the ankle are partially or completely torn. Ankle complex injuries in sport sports rehabilitation and. There is no consensus on optimal exercise content and training volume in this field. Here are some things to consider when rehabilitating your ankle. Interestingly, malliaropoulos found that lowgrade acute lateral ankle sprains result in a higher risk of reinjury than highgrade acute lateral ankle sprains. An ankle sprain is a stretch or a tear of the ligaments bands of tissue that hold bones together supporting the ankle joint. Nov 16, 2016 lateral ankle sprains are the most common musculoskeletal injuries in physically active populations. Aug 20, 2018 however, lateral ankle pain from a suspected inversion injury of the ankle may be more than a grades i, ii, or iii ankle sprain. The first two usually are treated non surgical, by cast or brace for about 46 weeks. However, for chronic lateral ankle instability unresponsive to conservative treatment, surgical repair or reconstruction is recommended and can restore active patients to full athletic function. The most commonly involved ligament is the anterior talofibular ligament atfl, followed by the calcaneofibular cfl and posterior talofibular ligament ptfl.
Rehabilitation exercises reduce reinjury post ankle sprain. I think this is a great exercise teammates could add to their strengthening and conditioning programs. Foot and ankle rehabilitation exercises orthoinfo aaos. Lateral ankle sprains are more common, and athletes are at a significantly higher risk of sustaining one. Doctor answers on symptoms, diagnosis, treatment, and more. Decrease pain and swelling, protect from further injury pain and swelling management rice protection of injured ligaments taping, splints, casting, walking boot etc. Butler md, in essentials of physical medicine and rehabilitation fourth edition, 2020. Also included is a discussion of the efficacy of manual therapy in the treatment of ankle sprain. The high rate of failure after ankle sprain treatment might be explained by overlooked associated lesions, such as syndesmosis or cartilage injuries 17. Elevate the ankle above heart level until swelling subsides. Physical therapy management of lateral ankle sprain. Inversiontype, lateral ligament injuries represent approximately 85% of all ankle sprains.
Grade 1 represents a sprain or stretch, usually with mild tenderness and swelling, minimal pain on bearing weight, and a normal stress examination. Diagnoses summary sheet 2116 lateral ligament sprain inversion sprain chronic ankle sprain and instability syndesmotic sprain high ankle sprain medial ligament sprain deltoid 1. Ankle sprains need to be rehabilitated properly to prevent reinjury or a chronic problem from developing. Rethinking our approach to the management of lateral ankle sprains is. Pdf functional instability following lateral ankle sprain. Ankle sprains are the most prevalent athleticrelated musculoskeletal injury treated by athletic trainers, often affecting activities of daily living and delaying return to play.
Primary care providers do not regularly promote formal rehabilitation for these. However, lateral ankle pain from a suspected inversion injury of the ankle may be more than a grades i, ii, or iii ankle sprain. In high impact, contact and pivoting activities, as well as in jumping and landing, a high proportion of the injuries will affect the lower limb, namely the ankle joint 24. Manual therapy is started within 48 h after the injury when ankle dorsiflexion is restricted. Ligaments are bands of tissuelike rubber bandsthat connect one bone to another and bind the joints together. Ankle sprains in youth sports medicine jama pediatrics. Dec 15, 2015 lateral ankle ligament injuries are graded 1, 2, or 3 fig 2. The development of chronic ankle instability is consequent on the interaction of mechanical and. Acute treatment and rehabilitation of the lateral ankle sprain. It is particularly important in the ankle joint where sprains are one of the m. Care should be taken with nonsteroidal antiinflammatory drugs nsaids usage after an ankle sprain. Lateral ankle sprains are referred to as inversion ankle sprains or as supination ankle sprains. Intrinsic and extrinsic risk factors for lateral ankle.
Most high ankle sprains are treated nonsurgically with a rehabilitation program. Rehabilitation rehab exercises are critical to ensure that the ankle heals completely and reinjury does not occur. The incidence of ankle sprain is highest in sports populations. Proprioception, your ability to tell the precise position of a joint, is also impaired when your ankle is sprained. Pdf with the high percentage up to 75% of initial lateral ankle sprains las leading to repetitive sprains.
View large image view hires image download powerpoint slide. It is usually indicated for grade iii ankle sprain a metaanalysis that looked at controlled trials of surgery for acute ruptures of lateral ankle ligaments found that compared with functional treatment, patients treated with surgery were. A sprained ankle, also known as a twisted ankle, or rolled ankle is an injury where sprain occurs on one or more ligaments of the ankle. Case of neglected achilles rupture after an ankle sprain.
A new paradigm for rehabilitation of patients with chronic. How to rehabilitate lateral ankle sprains what does the. Surgical repair of ruptured ankle ligaments is sometimes considered in patients with ankle sprains. Lateral ankle sprains are one of the most common injuries in athletes. According to brigham and womens hospital department of rehabilitation services, frequency and duration recommendations for a patient with an ankle sprain are 2xweek for 48 weeks 3xweek for first 2 weeks may be indicated for severe pain, swelling or functional impairment. Increase pain free range initial stage rehabilitation 2 5 days it is found that after ankle sprain, there is restriction of. Chattanooga, tn 423 6242696 the injury ankle sprains are very common ankle injuries, usually the result of the ankle turning inward. For anyone suffering from an ankle sprain or twisted ankle this video from 2014 can help. Rehabilitation after ankle sprain brett sanders, md center for sports medicine and orthopaedic 2415 mccallie ave.
Most ankle sprains result from the ankle turning inwards during an activity. Some people with repeated or severe sprains can develop longterm joint pain and weakness. Ankle sprain rehabilitation orofino physical therapy. To outline rehabilitation concepts that are applicable to acute and chronic injury of the ankle, to provide evidence for current techniques used in the rehabilitation of the ankle, and to describe a functional rehabilitation program that progresses from basic to advanced, while taking into consideration empirical data from the literature and clinical practice. High ankle sprains are common in athletes who play contact sports. Strengthening the muscles that support your lower leg, foot, and ankle will help keep your ankle joint stable. Anterior talofibular ligament, posterior talofibular ligament. Current concepts on the pathophysiology and management of.