Rehabilitation for Ankle Sprain

Introduction

Ankle sprains are common injuries affecting all types of people, from athletes to the elderly. Any treatment of serious sprains, including surgery, must involve intense physiotherapy to return the strength and suppleness of the soft tissues around the ankle.

Rehabilitation following an ankle sprain will vary greatly depending on:

  • The severity of the injury - see Grades below
  • The activity of the patient, eg will you return to high-impact sports after your sprain

These two factors change the length, intensity and exercises used during rehabilitation. This guide is therefore meant to only provide a rough outline of what you may experience - always refer to your physiotherapist for advice.

General Principles of Rehabilitation

In the early period after injury, your ankle needs to be protected (ie non-weight-bearing, non movement), and swelling needs to be controlled with frequent elevation of the ankle and icing.

NB Rehabilitation exercises are dsigned to provoke growth and change in the injured ligaments to improve the scar. This means that some degree of swelling and inflammation may continue throughout your rehabilitation, especially after performing your exercises. This is to be expected, but you should raise any concerns with your physio.

The ankle is a moving dynamic structure, and consequently movement ('mobilisation') as soon as safe is necessary for good recovery. Keeping the ankle in a cast or rigid brace (immobilisation') for long periods of time will require longer periods of rehabilitation to recover full function.

 

Grades of Ankle Sprain

Your surgeon or physiotherapist will decide on the severity of your ankle sprain by examining your ankle and possibly getting X-Rays (usually weight-bearing).

The 'grade' of ankle sprain reflects the severity of the injury, with grades 1 & 2 indicating mild-moderate injury and grade 3 indicating severe sprain.

  1. A Grade 1 sprain is defined as injury with no evidence of rupture of ligaments (and hence little, if any instability in the ankle) and limited swelling. Grade 1 sprains require the shortest period of rehabilitation and rarely require any full immobilisation.
  2. Grade 2 sprains have partial tears through the ligaments (with some degree of instability) and moderate swelling around the ankle.
    • Grade 1 and 2 sprains usually do not require full immobilisation in a plaster cast, and can instead be 'protected' by a removeable boot or nonrigid functional ankle brace.
  3. Grade 3 sprains are the most severe, and have similar symptoms to a mild ankle fracture. In these sprains, the ligaments have ruptured. Consequently, the ankle feels very unstable and weight-bearing is difficult or impossible. Bruising & swelling is also severe and requires a longer phase 1 of icing and elevation.
    • Unlike grades 1 and 2, grade 3 sprains usually require a period of complete immobilisation, usually in a cast. The plaster may need to remain in place for up to 4 weeks. During this time, you may require crutches to move around.