ANATOMY OF A TORN LIGAMENT?

Ligaments are bands of connective tissue that run from one bone to another across a joint. Ligaments allow for some motion in the joint but restrict excessive motion as they are not very elastic. 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 the ankle joint is moved beyond its normal range of motion it stresses and stretches the inelastic fibers of the ligaments and can cause tearing. Ankle ligament tears often occur 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 sprains or a condition that promotes hypermobility, may experience repeated tears in a given area.

An injury to the ligaments of the ankle is also known as an ankle sprain.The most common ankle 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. We grade these injuries based on how severely injured the ligament is damaged:

• 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.

As you can see, grade II and III sprains are characterized by a tearing of the ligament. Partial tears have more capacity to heal than complete tears which is why a complete tear may require surgery or at least a prolonged period of immobilization to allow the fibers to knit back together.

With a more severe ligament tear 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 tear 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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PHYSICAL THERAPY INTERVENTIONS FOR PIRIFORMIS SYNDROME

PHYSICAL THERAPY FOR A LIGAMENT TEAR In the first week or so after an ankle ligament tear, your physical therapist will guide you on how to protect the recently injured and newly healing ligament. This may include the use of an assistive device like crutches. Immobilization with a splint is typically prescribed for one to several weeks after a grade II or III tear. While you may need to wear the splint while you are walking and active, your physical therapist will guide you through a process of restoring ankle motion during therapy. You want to minimize any movement that causes pain or places any stretch or strain across the injured site in the first phase of recovery but your physical therapist may passively move the ankle through small ranges of motion even from the start to prevent stiffness. As you move into subacute and chronic phases of healing and rehabilitation, your physical therapist will prescribe active motion and then resistance type exercises to facilitate continued healing and restore normal ankle strength and mobility. Exercises begin in a non weight bearing position and gradually progress to standing and weight bearing. Your therapist will monitor for any return of increased pain or swelling as you progress through your program. They may also utilize treatments such as soft tissue mobilization, taping, joint mobilization and modalities to manage pain and stiffness and promote ligament fiber alignment. 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 you love to do. CALL TO SCHEDULE AN EVALUATION WITH EVOLVE PT While a ligament tear in the ankle can be frustrating, 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. Call to schedule an evaluation today.

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