Lateral Ankle Sprains: Injury & Treatments | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Lateral Ankle Sprains: Injury & Treatments

Lateral Ankle Sprains: Injury & Treatments


GRADE I (mild):
  • Ligament fibre stretch, no rupture.
  • Minor swelling.
  • Palpatory tenderness.
  • Minor functional loss.
  • No increased instability.

GRADE II (moderate):
  • Partial ligament tear.
  • Moderate pain.
  • Swelling and palpatory tenderness.
  • Mild instability.
  • Moderate functional disability.

GRADE III (severe):
  • Complete tear of ligament and joint capsule. Severe bruising, swelling, pain.
  • Significant loss of function.
  • Increased instability.
  • Unable to bear weight.Lateral Ankle Sprains: Injury & Treatments
Non-operative measures for Grades I–III have good to excellent outcomes.

Treatment is based on the 3 phases of biological ligament healing:
  • Inflammatory
  • Proliferation
  • Remodelling.
Avoid swelling and ongoing injury. 
POLICE 4-5 days:
  • Protect
  • Optimal loading
  • Ice
  • Compression
  • Elevation
NSAIDs decreases pain without adverse events.
Manual therapy has minimal benefits.
No effect found from ultrasound, laser, or electrotherapy.
Short-term brace (<10 days) for Grd III, can speed recovery vs. compression bandage.
Long-term brace (> 2 weeks) leads to poorer outcomes. .
Controlled stress promotes proper collagen orientation.
Protection from prevents formation of weaker type III collagen. .
External ankle brace can help, mores than tape.
Exercises are essential:
  • Early active range of motion
  • Strengthening
  • Proprioceptive
  • Functional
Simulate physical demands of sport: Jumping.
  • Turning
  • Twisting
Supervision by a multidisciplinary team is helpful.
Functional treatment is preferred over surgery.
Surgical treatment may be beneficial in some elite athletes.
  • Timing in the season
  • Expectations
  • Sports specific ankle load
  • Individual history
  • Stage of career
  • Time to diagnosis
  • Combined injury
  • Access to expert imaging and treatment

Thoughts? Questions? Comments?
Comment on @physicaltherapyresearch instagram - reposted with permission
#physicaltherapyresearch #atfl # anklesprain
D’Hooghe, et al. 2020. Return to Play After a Lateral Ligament Ankle S

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 
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