A 22-year-old male presents with right ankle pain after twisting his foot while playing football. He reports swelling, difficulty weight-bearing, and pain during walking. There is no history of fracture.
This is a common presentation of lateral ankle sprain.
Step 1: Subjective Assessment
Key questions include:
- Mechanism of injury (inversion or eversion)?
- Was there immediate swelling?
- Was weight-bearing possible immediately?
- Previous ankle injuries?
Inversion injuries commonly affect the anterior talofibular ligament (ATFL).
Red flags such as suspected fracture (based on inability to bear weight or severe tenderness over bone) must be ruled out.
Step 2: Objective Assessment
Observation
- Swelling
- Bruising
- Gait pattern
- Weight-bearing ability
Palpation
Tenderness over:
- ATFL
- Calcaneofibular ligament
- Posterior talofibular ligament
Range of Motion
Assess dorsiflexion, plantarflexion, inversion, and eversion.
Special Tests
- Anterior drawer test
- Talar tilt test
Grading of Ankle Sprain
- Grade I: Mild ligament stretch
- Grade II: Partial tear
- Grade III: Complete tear
Grading helps determine rehabilitation progression.
Rehabilitation Phases
Phase 1: Acute Phase (0–5 Days)
Goals:
- Control pain and swelling
- Protect the ligament
- Maintain mobility
Management:
- Relative rest
- Compression
- Elevation
- Gentle range of motion exercises
Avoid complete immobilization unless severe.
Phase 2: Subacute Phase
Goals:
- Restore range of motion
- Begin strengthening
- Improve weight-bearing
Interventions:
- Active mobility exercises
- Isometric strengthening
- Partial weight-bearing progression
Phase 3: Strengthening and Proprioception
Goals:
- Improve ankle stability
- Prevent recurrence
Interventions:
- Resistance band exercises
- Heel raises
- Balance training (single-leg stance)
- Proprioceptive board exercises
Proprioception is critical in preventing recurrent sprains.
Phase 4: Functional and Return to Activity
Goals:
- Restore agility
- Improve coordination
- Prepare for sport-specific tasks
Interventions:
- Hopping drills
- Lateral movements
- Gradual return to running
Return-to-sport decisions should consider strength symmetry and pain-free functional movement.
Common Complications
If not managed properly, ankle sprains may lead to:
- Chronic ankle instability
- Recurrent sprains
- Persistent swelling
- Reduced confidence in movement
Early physiotherapy intervention reduces these risks.
Clinical Reasoning Summary
The key to physiotherapy management of ankle sprain is:
- Accurate grading
- Progressive loading
- Proprioceptive retraining
- Functional restoration
Avoiding prolonged rest and promoting controlled movement improves long-term outcomes.
Conclusion
Physiotherapy management of ankle sprain involves structured assessment, graded rehabilitation, and prevention strategies. With timely intervention and progressive strengthening, most patients regain full functional mobility and return safely to activity.