ANKLE SPRAIN

Wan Fadzlin Bt Wan Shukry

Sports
4242132014
 TYPE OF ANKLE SPRAIN

Inversion Ankle
Sprain(Lateral)

Eversion Ankle
Sprain(Medial

High Ankle Sprain

 ETIOLOGY

A sprain occurs when the ankle is forced

to move out of its normal position, which
can cause one or more of the ankle's
ligaments to stretch, partially tear or tear
completely.

Causes of a sprained ankle might

include:

A fall that causes your ankle to twist

Landing awkwardly on your foot after

jumping or pivoting

Walking or exercising on an uneven

surface
 MECHANISM OF INJURY
Inversion Ankle Sprain(Lateral)

The most common type of ankle sprain occurs when

the foot is inverted too much, affecting the lateral
side of the foot.

When this type of ankle sprain happens, the outer,

or lateral, ligaments are stretched too much.

The anterior talofibular ligament is one of the most

commonly involved ligaments in this type of sprain.
 Eversion Ankle Sprain(Medial)

A less common type of ankle sprain is called an

eversion injury, affecting the medial side of the foot

This happens when the foot, instead of the ankle

rotating medially resulting in an inversion (the foot
being rolling to the inside), the ankle rotates laterally
resulting in an eversion (when the foot rolls to the
outside).

When this occurs, the medial, or deltoid, ligament is

stretched too much.
 High Ankle Sprain
A high ankle sprain, also known as a syndesmotic
sprain, is a sprain of the syndesmotic ligaments that
connect the tibia and fibula.

High ankle sprains are described as high because

they are located above the ankle.

Unlike the common lateral ankle sprains, when

ligaments around the ankle are injured through an
inward twisting, high ankle sprains are caused when
the lower leg and foot externally rotates (twists out).
 GRADING OF SPRAIN

Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament.

Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in
certain ways, abnormal looseness (laxity) of the ankle joint occurs.

Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the
ankle joint in certain movements, gross instability occurs.
 SPORTS INVOLVE
Soccer

Hockey/Ice Hockey

Netball/Basketball

Rugby

Ballet

Gymnastic

Badminton/Tennis

Running

Jumping

Horse Riding

Roller Blade/Ice Skating

 Ant.Drawer Test:

The ant. Drawer test is used to examine the

integrity of the anterior talofibulae ligament,
which is frequently injured during an
inversion ankle sprain.

PT position: Pt stabilizes the tibia and

fibula with one hand and grasps the
calcaneus with other.

pt position: pt is seated on a table with the

knee flex to 90 degree and involved the foot
relaxed slight plantarflexion.This also can be
performed with pt in a prone position

Action: While assuring stabilization of the

distal tibia and fibula, PT applies an ant.
force to the calcaneal and talus.

Positive Findings: Pain/ increased joint

laxity in the injured ankle indicates
disruption of the ant. talofibular ligament.
 Talar Tilt Test:

The Talar tilt test is a ligamentous stress test

that examines the integrity of the lat. ankle
ligaments, particularly the calcaneofibular
ligament.

PT position: PT stabilizes the distal tibia with

one hand while grasping the talus with the
other.

pt position: pt lies on the uninvolved side on

table with the involved foot relaxed and knee
flexed to 90 degree.

Action: PT first places on foot in the neutral

and dorsiflexion.Then PT tilts the talus into an
abducted position.

Positive Findings: Positive findings include

any pain in the ankle or increased joint
laxity.Depending on the positioning of the ankle
,pain may be experienced over either the
calcaneofibular ligament or the ant. talofibular
ligament.
 SPECIAL TEST
Compression Test:

This test examine the integrity of the distal

tibiofibular joint.

PT position: The examiner stands next to

the pt's leg and notes where the pain
originates.

pt position: Pt lies supine with affected

leg extended and the ankle just off then
bed.

Action: PT squeezes the tibia and fibula

together at some point away from the
painful area.

Positive Findings: Any pain inthe lower

leg may be indicative of a syndesmotic
sprain (High Ankle Sprain)
 Dr.MANAGEMENT
Medications-In most cases, over-the-counter pain relievers —
such as ibuprofen (Advil, Motrin IB), naproxen (Aleve) or
acetaminophen (Tylenol) — are enough to manage the pain of
a sprained ankle.

Devices-Because walking with a sprained ankle might be

painful, you may need to use crutches until the pain subsides.
Your doctor might also recommend that you use a removable
plastic device such as a splint.

Surgical and other procedures-If your ankle joint is unstable,

your doctor may refer you to a musculoskeletal specialist for
evaluation. You may need a cast or walking boot to immobilize
your joint so that it can heal properly. In rare cases of severe
ligament tears, particularly in elite athletes, your doctor might
recommend surgery to repair the damage.
 Physiotherapy
Management
http://www.physiotherapy-treatment.com/ankle-
sprain-treatment.html

http://www.deroyal.com/filedisplay.aspx?id=33
3
THANK YOU
 PHYSIOTHERAPY MANAGEMENT

-Grade 1 sprain: 1-3 days

-Grade 2 sprain: 2-4 days

-Grade 3 sprain: 3-7 days

Goals-Acute Stage-Ankle Sprain Treatment

Decrease pain and swelling, protect from re injury and maintain appropriate weight bearing status.

PRICE

1) Protection Options Taping, functional bracing, removable cast boot (grade2 and 3 sprains)

2) Rest (crutch to promote ambulation).

3) Ice Cryocuff ice machine, ice bags, ice with other modalities (interferential , ultrasound, high-
voltage galvanic stimulation).

4) Compression Elastic wrap, TED hose, Vaso-pneumatic pump.

5)Elevation Above heart level with ankle pump.

 Sub-Acute Stage- Ankle Sprain Treatment

-Grade 1 sprain: 2-4 days

-Grade 2 sprain: 3-5 days

-Grade 3 sprain: 4-8 days

Goals-Sub-Acute Stage-Ankle Sprain Treatment

Decrease pain and swelling, increase pain free range of motion, begin strengthening, begin non-
weight bearing proprioceptive training and provide protective support as needed.

1) Modalities to decrease pain and swelling

-Ice

-Electrical stimulation (high-voltage galvanic or interferential)

-Ultrasound

-Soft orthotics with 1/8-3/16 inch lateral wedge, if needed in Ankle Sprain Treatment.
2) Weight bearing

-Progress weight bearing as symptoms permit. Partial weight

bearing to full weight bearing if no signs of antalgic gait is
present.

3) Physiotherapy exercises for ankle sprain

-Active range of motion exercises- Dorsiflexion, inversion, foot

circle, plantarflexion, eversion, alphabet.

-Strength exercises- Isometrics in pain free range, toe curls with

towel (place weight on towel to increase resistance). Pick up
objects with toes (tissue, marble).

-Stretching- Passive ROM- only dorsi flexion and plantar flexion

in pain free range. No eversion or inversion yet.
Rehabilitative Stage- Ankle Sprain Treatment

-Grade 1 sprain:1 week

-Grade 2 sprain:2 week

-Grade 3 sprain:3 week

Goals- Rehabilitative Stage- Ankle Sprain Treatment

Increase pain-free ROM. Progress strengthening. Progress proprioceptive training. Increase pain-free
activities of daily living. Pain-free full weight bearing and uncompensated gait.

1) Therapeutic exercises for ankle sprain

-Stretching- of gastrocnemius and soleus with increased intensity. Joint mobilization (grades 1,2 and 3
for dorsiflexion, plantarflexion, and eversion, hold inversion).

-Strengthening- Weight bearing exercises. Heel raises. Toe raises. Stair steps. Quarter squats.

Concentric/Eccentric and isotonics (theraband and weight cuff exercises) for inversion, eversion,
plantar flexion, dorsi flexion, peroneal strengthening.

-Proprioceptive training ( Progress from non-weight bearing to controlled weight bearing to full weight
bearing). Standing BAPS board. Standing wobble board. Single leg balance activities (Stable to
unstable surfaces, without to with distractions). Proprioceptive training has a major role in Ankle Sprain
Treatment.