Physiotherapy treatment protocols for sprained ankles - Health

Sprained ankles are very common and repeated sprains can lead to a swollen, painful ankle, problems walking on rough ground and the risk of re-injury. The physiotherapist begins with asking: How did the injury occur? Was there a high level of force involved? What happened afterwards - could the patient walk or did they go to hospital? Was there an x-ray?

The pain levels after injury indicate important things about the joint. High levels of pain or pain not subsiding normally could imply a fracture and the physiotherapist will ask for a medical review. This injury should give pain in certain areas which point towards the damaged parts of the ankle anatomy. The physio will test these structures later in the examination.

Special questions are asked about the past medical history and previous injuries, any drugs the patient is taking, their appetite level, whether they are losing weight, their sleep quality and pain in the morning, their bladder and bowel normality and any relevant family history. This is to clear the patient of any serious underlying condition so that treatment can be safely performed.

How Physiotherapists examine a sprained ankle

Movements of the ankle noted up on the bed without weight bearing are dorsiflexion (pulling the ankle up), plantarflexion (pointing the foot down), eversion (turning the foot outwards), and inversion (turning the sole of the foot inwards toward the other foot). The movements tell the therapist about the willingness of the patient to move in the presence of pain and anxiety and limited movements give important information about the joint.

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.

Manual therapy moves the joint surfaces, restoring the normal sliding and gliding movements which allow normal joint action. Once the pain and stiffness have been reduced the physio can start working on weight bearing exercises. Initially this consists of toe raises and walking on the heels, progressing to walking quicker and running.

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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