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Ankle Sprain or Twisted Ankle

A sprained ankle or twisted ankle is a common cause of ankle pain. More common is an inversion sprain (or lateral collateral ligament sprain) where the ankle turns over so the sole of the foot faces inwards, damaging the ligaments on the outside of the ankle.

A medial ligament sprain (deltoid ligament tear) is rare but can occur particularly with a fracture. This happens when the ankle rolls the other way, so the sole of the foot faces outwards, damaging the ligaments on the inside of the ankle.

The lateral collateral ligament comprises of 3 bands connecting the fibula anteriorly and posteriorly with the talus and with a 3rd band in-between the other two connecting with the calcaneum. Severe the injury more the no. of bands injured.

In addition to the ligament damage there may also be damage to tendons, bone and other joint tissues, that is why it is important to consult a professional to diagnose the ankle sprain.

Grades of Severity for Sprained Ankles:

An ankle sprain with all ligaments involved can be divided into 3 grades.

Grade 1 sprain:

  • Some stretching or perhaps minor tearing of the lateral ankle ligaments.
  • Little or no joint instability.
  • Mild pain.
  • There may be mild swelling around the bone on the outside of the ankle.
  • Some joint stiffness or difficulty walking or running.

Grade 2 sprain:

  • Moderate tearing of the ligament fibers.
  • Some instability of the joint.
  • Moderate to severe pain and difficulty in walking.
  • Swelling and stiffness in the ankle joint.
  • Minor bruising may be evident.

Grade 3 sprain:

  • Total rupture of a ligament.
  • Gross instability of the joint.
  • Severe pain initially followed later by no pain.
  • Severe swelling.

Ankle Sprain


Diagnosis can be made by properly evaluating the patient. An MRI may be needed to find the severity of ankle sprain.


Immediate First Aid for a sprained ankle:

Aim is to reduce the pain and swelling by PRICE as soon as possible.

P is for PROTECTION. The injured ankle should be protected with utmost care to prevent any further injury.

R is for REST. It is important to rest the injury to reduce pain and prevent further damage. Use crutches it necessary. Many therapists advocate partial weight bearing as soon as pain will allow. This is thought to accelerate rehabilitation.

I is for ICE or cold therapy. Applying ice and compression can ease the pain, reduce swelling and reduce bleeding (initially). Apply ice pack for 10-15 mins every 3-4 hours following the injury.

C is for COMPRESSION – This reduces bleeding and helps reduce swelling.

E is for ELEVATION – Uses of gravity to reduce bleeding and swelling by allowing fluids to move away from the site of injury.

Further treatment

In cases of severely injured ankle (grade 2 and 3) cast can be applied for 3-6 week as per the orthopedics decision. At times surgical intervention may be needed.

Following the initial treatment with PRICE in  painful phase of grade 1 sprain (and in some cases of grade 2 where cast is not indicated), or after removal of cast in severe cases, physiotherapy treatment can help the ankle return to normal as soon as possible.

Physiotherapeutic modalities like LASER therapy, Ultrasonic therapy and TENS can help reduce pain further and promote healing. Hot fomentation can increase the circulation of the area which further promote healing and increase the pliability of the tissues. Wax bath instead of hot fermentation can be used in cases where cast was applied.

To strengthen the soft tissues around the ankle start with gentle isometric (tension building without movement) exercises, followed by range of motion exercises within the pain free limits. As for e.g. Writing the alphabets A-Z with the great toe on the floor, heal raises in sitting etc. Approach a physiotherapist to learn more.

Strength can be further developed though resisted exercises with the help of Theraband.

The techniques like cross frictional massage and ligament stretching can be implemented to prevent adhesion formation and to maintain the flexibility of the ligaments. This helps to reduce the chances of recurrent ankle sprain problems.

The calf muscles often tighten up to protect the joint following a sprained ankle, and so gently stretching the calf muscles can also help to maintain movement at the joint.

A wobble balance board is an important part of rehabilitation of ankle sprains to improve the balance and proprioception (joint sense) which generally gets hampered after any injury.

Any biomechanical fault of the foot needs to be corrected with orthotic aids. Complete leg strengthening exercise programme should be started. Sport based small exercise programmes to gain back the agility, proprioception, speed and endurance.

Contact Pain Free Physiotherapy Clinic for Physiotherapy treatment of ankle sprain.

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