Lateral Ankle Sprains: Injury & Treatments

Lateral Ankle Sprains: Injury & Treatments

INJURY GRADES

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.

✅✅
TREATMENT:
Non-operative measures for Grades I–III have good to excellent outcomes.
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Treatment is based on the 3 phases of biological ligament healing:

Inflammatory
Proliferation
Remodelling.

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INFLAMMATORY:
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Avoid swelling and ongoing injury.
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POLICE 4-5 days:

Protect
Optimal loading
Ice
Compression
Elevation

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NSAIDs decreases pain without adverse events.
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Manual therapy has minimal benefits.
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No effect found from ultrasound, laser, or electrotherapy.
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Short-term brace (<10 days) for Grd III, can speed recovery vs. compression bandage.
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Long-term brace (> 2 weeks) leads to poorer outcomes. .
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PROLIFERATION (6-12 wks):
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Controlled stress promotes proper collagen orientation.
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Protection from prevents formation of weaker type III collagen. .
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External ankle brace can help, mores than tape.
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Exercises are essential:

Early active range of motion
Strengthening
Proprioceptive
Functional

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REMODELLING (1 yr):
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Simulate physical demands of sport: Jumping.

Turning
Twisting

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Supervision by a multidisciplinary team is helpful.
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Functional treatment is preferred over surgery.
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Surgical treatment may be beneficial in some elite athletes.
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Considering:

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
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SOURCE:
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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