Ankle Sprain/Strain- Active vs Passive Care

Often times I get a new patient that wants a second opinion about an ankle sprain/strain that occurred months to years ago. He/she received treatment, yet they are still in pain. Typically, the patient presents with pain after walking for a long period, after running for short distances, or they feel a sense of weakness or instability in the joint. This patient most likely was told to immobilize the ankle until the inflammation and pain subsides, and then go for some form of physical therapy to strengthen the muscles around the ankle.

Unfortunately, this type of outdated advise continues to be provided to patients. The truth is healing from an ankle sprain requires three stages of treatment to fully improve. When the initial evaluation is conducted the practitioner must first determine the severity of the injury- grade I, II, or III with grade I being more of a ligamentous and muscle stretch injury and grade III representing a frank tearing of tissue. For grades I and most grade II strains treatment should commence immediately (grade III strains may require an MRI and then surgery before rehabilitation begins). Initial treatment should incorporate passive treatments such as laser therapy, electric stimulation, and/or ultrasound therapy to control edema and accelerate healing. A slow deep manual flush from the foot up the leg can also be performed to move excess edema. However, scar tissue prevention, which is critical for rapid, complete healing must also be included. This can be achieved by incorporating Instrument Assisted Soft Tissue Mobilization (an external method to scrape early onset scar tissue out of the area of injury), Active Release Technique, and gentile ankle mobilization.

When the injury has started healing and the inflammation has begun to subside (usually day 3-7 after injury) stage 2 of rehabilitation can commence. This stage focuses on laser therapy to provoke cell regeneration, and low impact strengthening and balance training. It is not enough to just strengthen. When ligaments and muscles go through the shock of an injury, these tissues lose their ability to perceive the bodies shift in position reducing a persons ability to stay balanced. Active range of motion of the ankle, slow, one foot toe raises with the shoe on, and low resistance exercise bands should be used. This stage can progress to more challenging exercises as stability is gradually restored. Using a Bosu Ball, or folded towels with shoe off is a good start. By the end of this stage a patient should be pain-free, inflammation-free, and feel confident about using the ankle.

The final stage of rehab involves reintroducing everyday fitness activities to a patient’s lifestyle. Using fitness ladders and jump boxes are just a couple examples of common tools to improve plyometric movements to the ankle. Starting slowly, a patient can reintroduce their favorite exercises back into their life. The total rehab time can be as little as 2 -3 weeks to 2 – 3 months. However, both active and passive forms of care are necessary immediately after injury to ensure full recovery.