Physiotherapy treatment protocols for sprained ankles

by Jonathan Blood-Smyth

One of the commonest general and sporting injuries is a sprained ankle and if it happens often it can give long-term problems with pain, falling and with rough ground. Physios start by asking about the cause of the injury, the amount of force involved, whether the person could walk after or go to the emergency department and were they x-rayed.

How badly the joint has been damaged is indicated by the levels of pain suffered after the injury. Very high pain levels or pain which does not steadily reduce are bad signs and the physiotherapist may ask for a review in case of a fracture or severe ligament injury. Where the ankle has been injured can be deduced from the site of pain and confirmed on later testing by the physio.

Routine screening questions include past injuries, bowel and bladder control, medication history, quality of sleep, family history and past medical conditions. This allows the physio to be sure that there is no serious pathology.

How Physiotherapists examine a sprained ankle

The physiotherapist will note any oedema, change of colour or abnormality of circulation. Ankle movements when not weight bearing are assessed by the physio, dorsiflexion is pulling the ankle upwards, plantarflexion involves pushing the foot down, eversion is turning the foot outwards and inversion turning the sole of the foot inwards. The physiotherapist assesses movement of the ankle as pain can limit movement and the readiness of the patient to engage in rehabilitation.

Manual testing of the ankle muscle strength by the physiotherapist indicates any muscle damage around the ankle. The physio tests the patient up on a couch or gets the patient to perform exercises up on their feet. Passive movement of the joint, where the physio moves the ankle and uses gentle stretching of the joint in each direction to test the structures of the joint. Palpation of the joint structures is used to find which structure is to blame.

Treatment protocols for Physiotherapy

Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling.

A compression dressing such as a joint sleeve reduces or prevent swelling or effusion occurring as swelling can interfere with normal joint movement, and the joint is kept up to prevent swelling due to gravity. A walking aid such as a stick or elbow crutches may be useful if pain is severe and normal weight bearing gait is not possible. The physio’s hands can test for stiffness or pain in the ankle and allow improvement of the joint gliding movements to normalize joint mechanics. Reducing stiffness of the joint loosens it and eases pain which allows exercises to start in weight bearing. Less dynamic exercises are used initially, progressing to active exercises without support.

Joint position sense tells the brain where the ankle is in all situations and the brain can quickly correct the ankle position and stop it getting into dangerous situations. The patient practices standing on one leg, progressing to standing on the wobble board, an unstable balance device. Balancing on a wobble board is hard work and retrains the joints and the brain to improve balance and coordination. Once the ankle has good range of motion, minimal pain, good strength, good gait and balance, the rehabilitation job is done and the patient’s ankle is likely to recover.

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