Ankle sprains are common sports injuries, especially in basketball, soccer, football, and running. This document provides treatment guidelines for both acute and chronic ankle sprains. The rehabilitation process involves regaining range of motion, strengthening muscles through exercises of increasing difficulty, training proprioception and balance, and returning to activity-specific training. Preventing relapses is important and can be aided by sports-specific and injury prevention exercises.

1. B.KANNABIRAN
Senior Sports Physio

2. Ankle Sprains in Sports
 53% - Basketball
 19% - Soccer
 9.3% - Football
 7.2% - Running

3. physical therapy guideline for
an chronic ankle complaint.

4. Impaired ankle function
Acute Chronic
POST TRAUMATIC
SYSTEMIC
TRAUMATIC A TRAUMATIC
INFECTION
OSTEOARTHRITIS

5. ACUTE ANKLE
FUNCTIONAL WITH NEW SPRAIN
INSTABILITY DAMAGE GUIDELINES
WITHOUT
NEW
SUBTALAR DAMAGE
INSTABILITY
CHRONIC
ANKLE SPRAIN
DISTAL GUIDELINES
TIBIOFIBULAR
POST SYNDESMOTIC
TRAUMATIC RUPTURE
WITH SOFT
TISSUE
OSTEOCHONDRAL IMPINGEMENT
LESIONS & DISCUSS
WITHOUT SOFT WITH
OSTEOPHYTE TISSUE REFERRING
IMPINGEMENT PHYSICISN
LOOSE
SINUS TARSI
BODIES/OCD
SYNDROME

6. Factors involved
functional instability
 Mechanical instability
 Disturbed Proprioception and balance
 Reduced muscle strength
 Slow muscle reaction times
 Reduced mobility
 Inappropriate complaint-related behaviour
 Inadequate acute ankle sprain rehab

7. Physical therapy treatment goals
 To achieve optimal functional recovery.
 The highest achievable or desired level of activities.
 To prevent relapses, exacerbations and further
dysfunction.

8. Functional Rehabilitation
 Prolonged immobilization of ankle sprains is a
common treatment error.
 Functional stress stimulates the incorporation of
stronger replacement collagen.
 The four components of rehabilitation are:
1. Range-of-motion rehabilitation
2. Progressive muscle-strengthening exercises
3. Proprioceptive training
4. Activity-specific training

9. Range of Motion
• Range of motion must be
regained before functional
activity is initiated.
• Regardless of weight-bearing
capacity, Achilles tendon
stretching should be instituted
within 48 to 72 hours after the
ankle injury because of the
tendency of tissues to contract
following trauma.

10. INCREASING THE RANGE OF MOTION
Achilles tendon stretch,

11. Range of Motion
ABCs Inversion / Eversion Ankle Pump
 Alphabet exercises, Move ankle in multiple planes of motion
by drawing letters of alphabet (lower case and upper case).
Repeat four to five times a day. Exercises can be performed in
conjunction with cold therapy.

12. PROGRESS ONCE ROM IS REGAINED
 Once range of motion
is regained, and
swelling and pain are
controlled, the patient
is ready to progress to
the strengthening
phase of rehabilitation.

13. Training strength
 Strengthening of weakened
muscles
 conditioning of the peroneal
muscles
 Strengthening begins with
isometric exercises and
progresses to dynamic
resistive exercises

14. Muscle Strengthening
 Isometric exercises,
 Plantar flexion,
 Dorsiflexion,
 Inversion,
 Eversion,
 For each exercise, hold 1 second for concentric component and
perform eccentric component over 4 seconds; do three sets of
10 repetitions; repeat two times a day.

15. Muscle Strengthening
 Toe curls and marble pickups, Two sets of 10 repetitions;
repeat two times a day. Toe curls can be done throughout
the day, at work or at home.
 Toe raises, heel walks and toe walks,

16. Heel walk & Toe walk

17. Training
strength

18. Training balance & proprioception

19. 747
 Stable platform
 747
 Reverse 747
 spokes

20. Reverse 747
 Stable platform
 747
 Reverse 747
 spokes

21. spokes
 Stable platform
 747
 Reverse 747
 spokes

22. Training balance and Proprioception

23. Training balance and Proprioception

24. Training on the Dyna disc

25. Training on the Bosu ball

26. Training on the Bosu ball

27. Training on the Bosu ball

28. Functional activities on
unstable platform

29. RETURN TO
ACTIVITY-
SPECIFIC
TRAINING

30. RETURN TO ACTIVITY-SPECIFIC
TRAINING

31. Complex activity training for
football player with chronic ankle
sprain

32. Composite drills

33. composite
drills

34. STRUCTURE OF REHABILITATION
IN SPORTS INJURY
 A stepwise approach
Increasing the level of difficulty
Increasing the speed, duration and dynamic quality of practiced
movements.
Training of specific skills
Reset Talus in Mortise
Peroneal tendon friction massage
fibular head mobility

35. Reset the Talus in the Mortise
• Apply traction with dorsiflexion and eversion
• Quick tug to reset the talus in the mortise

36. Peroneal Tendon Friction Massage
 Direct pressure to tendon in perpendicular direction
 Increases blood flow to the tendon
 Increases activity of fibroblasts
 Decreases fibrosis/adhesions
 Most effective with stretching and functional exercise

37. Correct posterior fibular head –
Passive Motion
•Patient supine, knee flexed
•Sit on foot
•Stabilize knee with hand
•Pull fibular head anterolaterally and
then push posteromedially repeatedly

38. Correct posterior fibular head –
Muscle Energy
Remember “PIP AID”
For a Posterior fibular
head, Invert and Plantarflex
For an Anterior fibular
head, Invert and Dorsiflex

39. Correct posterior fibular head - HVLA
•Patient supine, knee flexed
•Physician’s hand in
popliteal fossa, 1st MCP
joint behind fibular head
•Flex knee, externally rotate
leg at knee
•Thrust patient’s ankle
toward buttocks

40. Exercising functions and skills
• A symmetrical and dynamic gait should be
strongly encouraged.
• All relevant daily life activities should be exercised.

41. Training for Return to Activity
• When walking a specified distance is no longer limited by
pain, the patient may progress to a regimen of 50 percent
walking and 50 percent jogging.
• When this can be done without pain, jogging eventually
progresses to forward, backward and pattern running. Circles
and figure-eights are commonly employed for pattern running.
• Although these routines are time-consuming, they represent the
final phase and are essential for the recovery of ankle stability.

42. AQUA AEROBICS
 VERY USEFUL IN EARLY RETURN TO ACTIVITY

43. Plyometrics

44. Relapses prevention
TREAT WITH PRICER
NO MORE RICE REGIMEN FOR ANKLE

45. P.R.I.C.E.R Protocols
 Protect
 Rest limit weight bearing, crutches if necessary, an ankle
brace helps control swelling and adds stability
 Ice No ice directly on the skin, no ice more than 20 minutes
at a time to avoid frost bite.
 Compression can be helpful in controlling swelling
and is usually accomplished with an ACE bandage.
 Elevate above the waist or heart as needed
 Rehab
AOFAS updated Jan 2008

46. Relapses prevention
 After finishing therapy, to pay attention to sports
specific as well as prevention training.
 Use new sports shoes

47.  No taping or braces during training sessions use only
at high risk sports

48. Injury Prevention
 Neuromuscular Control is the ability to compensate
for uneven surfaces or sudden change in surfaces. It is
retrained by using balance and agility exercises such as
a BAPS board or standing on one leg with eyes closed
as well as using a single leg on a mini trampoline.

49. Take home message
 Treatment of ankle sprain should consist of an exercise
program that is as varied and intense as possible to
obtain optimal ankle functioning
 The target performance level should be achieved at the
end of treatment
 Do evaluate the eversion “red-headed step child”
 Whirl Pool/AquaAerobics If Accessible
 Of course Neuromuscular control

50. Thank you
for your attention

51. Questions?
…before hands-on practice

52. REFERENCES
 Immobilisation and functional treatment for acute
lateralankle ligament injuries in adults (COCHRANE
Review)Kerkhoffs GMMJ, Rowe BH, Assendelft
WJJ, Kelly KD, Struijs PAA, van Dijk CN(2009)
 Clinical practice guidelines for physical therapy in
patients with chronic ankle sprain RA de Bie PT
PhDI, MAMB Heemskerk PTII, AF Lenssen PT
MScIII, SR van Moorsel PTIV, G Rondhuis PTV,DJ
Stomp PT MScVI, RAHM Swinkels PT MScVII, HJM
Hendriks PT PhDVIII(ROYAL DUTCH SOCIETY
GUIDE LINE FOR PHYSIO 2003)