An ankle sprain is a very common injury but unfortunately, it is often not rehabilitated properly.
The first line of action is to rule out any possible fractures which, in this area, are not very obvious. If there are no signs of a fracture and the bones are intact, then we are dealing with a varying combination of muscle and ligament strains which can either be completely localized at the outer side of the ankle or in severe cases might involve the side of the foot and extend to the sides of the leg.
Simple ankle sprains involve just a few ligament fibers and it can settle down in just a few weeks and a normal joint function return is possible without needing any treatment.
A moderate case of an ankle sprain will cause discomfort during walking and there might be some obvious swelling accompanied by some discoloration and bruising. This type of sprain usually requires 3 to 4 weeks of complete rest but normal walking function should return within the first two weeks.
If the levels of pain are more severe and there is difficulty in conducting daily activities (for more than a week) then there might be some serious ligament damage which not only involves the Lateral ankle ligament (outer side of the foot) but might also involve the midfoot ligaments, medial ankle (inner ankle) and/or joint located above the ankle socket called Syndesmosis.
A couple of different clinical diagnostic tests can be used to determine the extent of the damage and prescribe the right course of action that is most suitable. Cartilage damage is another complicating factor involved in severe ankle sprains which also presents with bruising. Such cases need to be recognized and managed separately from common ankle sprains as they might require surgery and are certainly much more long-term and challenging to treat.
As far as physiotherapy is concerned, the key element here is to recognize the extent of the damage and plan a rehabilitation program that will achieve the fastest possible recovery. A sports physiotherapist would have a wealth of experience of assessing and treating ankle injuries.
The recurrence of ankle sprains is a major issue and there a huge volume of research is going on to address this problem. Despite conducting all this research, the most agreed upon conclusion is the risk of ankle sprain recurrence is increased if there is a previous sprain.
The matter complicates further by utilizing poor management strategies such as resting, taking it easy, and using anti-inflammatory medications. While these methodologies are important but they don’t offer any concrete or permanent solution. What we see in most cases is that the ankle pain subsides and proper functionality is restored but the ankle doesn’t feel right or there is some instability with sudden movements when walking on uneven grounds.
These issues present so frequently because in most cases some residual problems of reduced muscle strength, flexibility deficits, compensatory movements, and poor coordination are present which take the pressure away from the injury site.
A sports physiotherapist’s role is to identify and/or exclude the presence of any of these components and restore load tolerance/normal function to ensure that the pre-injury status is returned.
Once a ligament is stretches, it will not recoil to its original size. Therefore, a sports physiotherapists will prescribe exercise to improve the muscle control in the ankle.