Management of Ankle Sprains

Tom Byrne

Background:

The most common ankle sprain is a lateral ankle sprain (1a) which involves rolling over on the outside of the ankle causing damage to the lateral ankle ligaments (ATFL, CFL, PTFL).

The least common injury is a medial ankle sprain (1b) which involves rolling over on the inside of the ankle causing damage to the Deltoid ligament.

The ankle may present with some of the following symptoms:

Pain on palpation (touching) of the joint
Pain when weight bearing
Bruising
Swelling
Limited active range of motion (You carry out the movement)
Laxity in passive range of motion (Therapist carries the movement)
Numbness

Ankle sprain grades:

Grade I – Some stretching and damage to the ligament fibres. Minimal swelling and pain with little impact on function.

Grade II – Partial tearing of the ligament, often presenting with joint laxity. Moderate swelling and pain with decreased range of motion and stability.
Grade III – Complete tear of the ligament. Significant swelling and pain, loss of function and severe instability.

Early stage management:

Rule out a possible fracture!
Common practices in early stages of management include the POLICE (Protection, Optimal Loading, Ice, Compression, and Elevation) and the PRICE (Protection, Rest, Ice, Compression, and Elevation) protocols.
The POLICE protocol has been found to be the most effective of the two (Erdurmuş et al., 2023). The key difference between these protocols is optimal loading. This is the carrying out the right amount of activity that can help to manage swelling. The appropriate movement of the ankle through contraction of the calf muscles can help to move swelling up the body against gravity. However, this may not be appropriate if a fracture is present.

Rehab programme should aim to regain and improve:

Range of motion
Strength
Stability
Proprioception (Body’s ability to sense its location, movements, and actions) Reintroduce to running (if applicable to the person)

Range of motion:

Move ankle in all directions (eg. Up/down, in/out, circles, do the alphabet)
Knee-to-wall
Calf stretches

Stability:

Stand on one leg
Single leg squat
Plyometric exercises such as:
- Single leg hops (Forwards/backwards/sideways)
- Box jumps
- Drop jumps

Proprioception:

Stand on one leg on pillow/towel/wobble board
Stand on one leg with eyes closed
Stand on one leg while doing a task (ie. Brushing teeth, catching a ball)

Return to running:

Start with straight line running
Introduce bended runs with gradual change of direction
Further progress to sudden changes of direction

References

Erdurmuş, Ö.Y., Oğuz, A.B., Genç, S., Koca, A., Eneyli, M.G. and Polat, O., 2023. Comparison of the effects PRICE and POLICE treatment protocols on ankle function in patients with ankle sprain. Turkish Journal of Trauma & Emergency Surgery, 29(8), p.920.
Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome:Prevalence and analysis of 639 acute injuries. J Foot Ankle Surg. 1998; 37:280–5.
Wolfe, M.W., Uhl, T.L., Mattacola, C.G. and McCluskey, L.C., 2001. Management of ankle sprains. American family physician, 63(1), pp.93-105.