Lateral ankle ligamentous sprains are common sporting injuries and are prevalent in jumping and running sports like netball, basketball and all codes of “footy”. Referring to the functional anatomy of the ankle, the lateral supporting structures are much smaller in size in relation to the medial supporting structures and as a result, lateral ankle inversion injuries are much more common.
After sustaining an inversion injury there will be pain, swelling, bruising, and difficulty weight bearing. The presentation of these symptoms is
dependent on the grade of ligamentous sprain, which in turn will predict the period of rehabilitation required to return to sport.
There are three grades of ankle sprain Grade I – slight tearing or stretching of the ligament, with minimal swelling or bruising. The ankle feels stable and it is possible to weight bear with minimal pain. Rehab 4-6 weeks.
Grade II – more extensive ligamentous tearing without rupture. Moderate pain, swelling and bruising. Weight bearing is difficult due to increased pain. Rehab 6-8 weeks.
Grade III – complete rupture of the ligament with severe swelling and bruising. The ankle is unstable and weight bearing is impossible due to intense pain. Depending if surgery is indicated, rehab may take 3-6 months.
Accurate Physiotherapy assessment can identify the ligament injured and grade of injury. E.g. Grade II ATFL injury. A firm diagnosis gives the athlete confirmation of an injury and allows a rehabilitation programme to be planned with parents and coaching staff.
Rehabilitation of Lateral Ankle Sprain
The rehabilitation programme can be broken into three stages, completion of each is necessary to achieve a successful return to sport without the risk of re-injury.
In this initial stage the Physiotherapist will complete hands on massage, stretching and light mobilisation to aid removal of swelling and reduce pain. The patient will be educated on exercises to maintain lower limb strength and basic ankle movements. Use of crutches, moonboot or compressive garments may be necessary depending on grade of injury.
Sub-Acute/ Early Rehab stage
As pain, swelling, bruising and tenderness reduce, the Physiotherapist will continue with hands on massage and mobilisations to achieve greater ankle range of movement. The patient will complete stretching, strengthening and proprioception exercises in weight bearing to aid return of functional movement.
Late Rehab stage
The Physiotherapist will continue with mobilisation of the ankle joint to achieve full range of movement. Strength and flexibility should be 90% of the unaffected side at this stage. Sport specific proprioception exercises are very important and will reduce the risk of re-injury. To further reduce the risk, the Physiotherapist will advise on use of taping or protective ankle bracing if indicated, to aid a successful return to full sporting activity.
Research has shown that Individuals who have sustained an ankle injury are five times more likely to re-injure. Seeking prompt Physiotherapy assessment and treatment, in addition to following a full rehabilitation programme is of the upmost importance to achieve a successful return to sport.