Low and moderate grade sprains may require 4-6 weeks of physical therapy while higher grade sprains may take several months. The activities you are looking to resume also play a role in the length of your plan of care. An athlete looking to return to running on rocky trails may need more rehab than an individual who only walks on even sidewalks as the demands on the ankle are different. Your physical therapist can give you an estimate of your rehab timeline during the initial evaluation and regular reassessment will also guide the plan. Achieving long lasting results may take some time, but dedication to your home and clinic program will help you achieve these results more quickly.

WHAT HAPPENS WHEN AN ANKLE IS SPRAINED?

Ankle sprains often happen when walking or running on uneven terrain or when stepping awkwardly such as when unexpectedly stepping off a curb or step. Someone with increased laxity in their ligaments, whether due to chronic strains or a condition that promotes hypermobility, may experience repeated sprains in a given area. Ankles are made to perform four basic movements, dorsiflexion and plantarflexion (raising and pointing the foot) and inversion and eversion (moving the foot inward and outward). While the joint requires sufficient mobility to allow these motions it also needs enough stability to withstand all of the forces of weight bearing. The ligaments of the ankle play an important role in limiting motion, holding bones in the proper places and absorbing shock.

There are 3 main sets of ligaments in the ankle:

• Deltoid ligaments: ligaments on the inside or medial side of the ankle
• Lateral ligaments: ligaments on the outside of the ankle
• Syndesmotic ligaments: ligaments that connect the lower leg bones, the tibia and fibula, just above the ankle

When a joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligament and can cause tearing. In the ankle, the most common sprains are called inversion sprains which affect the lateral ligaments, eversion sprains which affect the deltoid ligaments and high ankle sprains which affect the syndesmotic ligaments. Because the primary function of ligaments is to provide passive stabilization to the area, loss of stability can range from mild to severe with a ligament 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 is 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 as well. 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

The Ottawa Ankle Rules are a set of criteria to help determine when an X-ray may be needed to evaluate for a fractured ankle bone. These rules suggest that the presence of pain in the area of the medial or lateral malleoli plus either inability to bear weight immediately and in the emergency or physician’s office or tenderness along the posterior edge of either malleoli indicate a need for an X-ray.

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If you decide to work with an ankle physical therapist to help correct your ankle issues, your entire treatment plan could consist of around 8-20 different ankle PT sessions that will each last 60-90 minutes. Once you complete your customized arm physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your ankle PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY FOR A SPRAINED ANKLE

In the first week or so after an ankle sprain, your physical therapist will guide you on how 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. They 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.

While no one wants to deal with a sprained ankle, having the right care team to help you recover can make all the difference. The team of physical therapists at Evolve is here and ready to get you started on the road to recovery today.

Call to Schedule a Consultation! 1-718-258-3300