Q: Doctor kindly guide about physiotherapy in ankle sprain, I recently had it during sports.
A: An ankle sprain is one of the most common injuries people face, especially among athletes and individuals who lead active lifestyles. It occurs when the ligaments around the ankle joint, which are responsible for stabilizing it, become overstretched or even tear. These tears can range from partial to complete, and the degree of damage determines the severity of the sprain. Most often, ankle sprains occur when the foot twists or rolls beyond its normal range of motion, leading to sudden, sharp pain that can make even standing a challenge. This injury is not exclusive to athletes, though it’s certainly more prevalent among those involved in sports or physical activities that demand quick directional changes, jumps, or awkward landings. But you don't have to be an athlete to suffer a sprain – something as simple as stepping awkwardly off a curb or misjudging your step on uneven ground can also lead to this type of injury.

Contributing Factors to Ankle Sprains
Several factors can increase the likelihood of someone suffering from an ankle sprain. These factors fall into two main categories: extrinsic and intrinsic. Extrinsic factors include external conditions or events that increase the risk, such as having a previous history of ankle sprains. When an ankle has been sprained before, the integrity of the ligaments is often compromised, making the ankle more vulnerable to future injuries. The damaged ligaments may lose some of their original strength and elasticity, and their ability to provide stability is reduced. Additionally, the sensory nerve fibers responsible for sending signals to the brain about the ankle's position can be affected, leading to reduced proprioception and making it harder for individuals to sense when their ankle is in a vulnerable position.

On the other hand, intrinsic factors are personal characteristics that inherently increase the risk of a sprain. These can include biological sex, height, weight, foot anatomy, and limb dominance. For instance, some studies have suggested that women are more prone to ankle sprains due to differences in ankle joint structure and muscle strength compared to men. Meanwhile, taller or heavier individuals may place greater stress on their ankles, increasing the likelihood of a sprain. Similarly, if someone has a natural tendency toward poor postural control or unusual foot mechanics (like having flat feet or high arches), this can also contribute to instability and raise the chances of injury.

Symptoms of an Ankle Sprain
The symptoms of an ankle sprain can vary greatly depending on how severe the injury is. Common symptoms include:

1. Pain, which is usually sharp and increases when weight is placed on the affected foot.

2. Tenderness when touching the ankle, particularly around the injured ligaments.

3. Bruising and swelling often develop within a few hours of the injury.

4. Limited range of motion in the ankle due to swelling or pain, making it difficult to move the joint naturally.

5. In some cases, individuals may complain of a cold sensation or numbness (known as paresthesia) in the foot, which could indicate nerve involvement, especially if the peroneal nerve has been compromised.

6. The injury may be the result of an inversion event, where the ankle rolls inward, or a forceful eversion where the ankle turns outward.

A patient’s medical history is a crucial part of diagnosing an ankle sprain, as previous ankle injuries significantly increase the risk of recurrence. Additionally, special tests such as the Anterior Drawer Test, Talar Tilt Test, or the Squeeze Test are often used by medical professionals to assess the specific ligaments involved. These tests aim to replicate the forces that may have caused the injury, helping to pinpoint the location and extent of the damage. For example, passive inversion (turning the foot inward without active movement by the patient) will typically reproduce symptoms in a lateral ligament sprain, while passive eversion will do the same for a medial ligament sprain.

Differential Diagnosis
While the symptoms of an ankle sprain can seem straightforward, it’s essential to rule out other possible injuries that could mimic the signs of a sprain. For example, a severe tendon rupture, tendinopathy (chronic tendon irritation), fractures, or tendon subluxation (where a tendon slips out of its normal position) could all present similarly. Diagnostic imaging, such as an ultrasound, is often used to confirm whether there’s tendon involvement. In more chronic cases where symptoms persist, imaging can be used to provide clarity, particularly when the Ottawa Rules (a set of guidelines used to determine whether imaging is necessary) don’t apply.

to be continued...