Ligaments are inelastic tissue fibers that connect one bone to another. They give joints the stability they need to prevent them from moving beyond their normal ranges of motion. They also hold bones in their proper places and absorb shock. The ankle has three main groups of ligaments. The Deltoid ligament is on the medial or inside of the ankle. The lateral ligaments are on the outside of the ankle while the syndesmotic ligaments are at the top of the ankle. A lateral ankle sprain is an injury to the ligaments on the outside of the ankle. Unlike the deltoid ligament, the lateral ligaments are not as strong and tend to sustain a sprain more often than the deltoid ligament. There are three ligaments on the lateral side of the ankle:

• Anterior talo-fibular ligament (ATFL)
• Calcaneo-fibular ligament (CFL)
• Posterior talo-fibular ligament.

Lateral ankle sprains tend to occur when the foot is forcefully pointed downward (a motion called plantarflexion) and rolled inward (a motion called inversion). This can stretch the inelastic fibers of the lateral ligaments beyond their limits causing some or many of the fibers to tear. This is known as a sprain. Pain on the outside of the ankle at rest, with weight bearing or movement of the ankle downward or inward are common symptoms of a lateral ankle sprain. Swelling, bruising and tenderness over the area can appear. Instability is not uncommon with a high-grade lateral ankle sprain.

We can categorize a sprain based on its severity:

Grade I (mild): microscopic damage has occurred to the ligament but only mild local tenderness and minimal bruising/swelling are noted without compromising joint stability. Typically takes 2-3 weeks to heal.

Grade II (moderate): partial tear/rupture of the ligament. Obvious swelling and tenderness noted over the injured ligament but joint instability is either minimal or absent. May require up to 6 weeks to heal.

Grade III (severe): complete rupture of the ligament with severe swelling and tenderness. This injury may be difficult to distinguish from a fracture initially. Instability of the joint is noticeable due to the severity of the rupture. Prolonged time to heal is frequent and may require surgery to repair.

With a more severe ankle sprain, it is important to rule out a possible ankle fracture. Signs and symptoms of a broken bone can overlap with those of a severe sprain and include:

• Pain, tenderness and swelling over one of the ankle bones
• Redness and bruising
• Difficulty walking on or moving the ankle

PHYSICAL THERAPY FOR A LATERAL ANKLE SPRAIN

In the first week or so after a lateral ankle sprain, it is important to protect the recently injured and newly healing ligament. You want to minimize any movement that causes pain or places any stretch or strain across the injured site. Your PT may recommend bracing or taping to protect the injured area and reduce pain or advise you to use crutches if you cannot walk without limping.

Aside from protecting the area of injury, in this very early phase, your physical therapy treatment will focus on reducing inflammation and pain and maintaining strength in unaffected areas above the injury. To achieve these goals your physical therapy treatment may consist of the application of ice or light soft tissue work to mobilize any edema. Modalities such as electrical stimulation or ultrasound may be applied to increase circulation, decrease inflammation and control pain.

As the healing tissues become stronger, inflammation subsides and pain is reduced, it is time to move on to the next phase of rehab which consists of light muscle activation and endurance work, graded active range of motion, and more weight-bearing activities. Finally, in the later stages of healing your physical therapy treatment will focus on exercises and activities that prepare the injured ligament to withstand the stress and strain of everyday life and the sports and recreational activities we love to do.

CALL TO SCHEDULE AN EVALUATION FOR YOUR SPRAINED ANKLE WITH EVOLVE PT

While no one plans to sprain their ankle, having a great rehabilitation program can lessen the recovery time. Call to schedule an evaluation with our team at Evolve Physical Therapy to get started on your healing journey today.