Classification of Ankle Sprains
Sprains are typically classified by the severity of the injury, which helps guide treatment and rehabilitation:

1. Grade I (Mild): The sprain involves minimal stretching of the ligaments, with mild tenderness and swelling. The individual may be able to walk with little difficulty, though there may be some discomfort.

2. Grade II (Moderate): The ligament is partially torn, leading to more significant pain, swelling, and difficulty moving the ankle. Walking becomes challenging, and there is often some instability.

3. Grade III (Severe): A complete tear of the ligament, with severe pain, swelling, and bruising. The ankle is very unstable, and the patient is likely unable to bear weight on the affected foot without intense discomfort.

A thorough assessment of the ankle is recommended, not just focusing on the sprained area but on the overall condition of the foot and ankle. This includes taking a detailed medical history to identify any previous injuries that might affect the healing process, as well as a visual examination to note any deformities, atrophy, or misalignment. The patient’s gait should be analyzed to see if they are compensating for the injury, which could lead to further complications. Palpation is used to check for tenderness over specific bones, muscles, or ligaments, and both passive and active ranges of motion are tested to assess the functional impact of the injury.

Physical Therapy for Ankle Sprains
Physical therapy plays a vital role in the recovery process, especially for athletes. The goals of therapy differ depending on the severity of the sprain and the stage of healing. For mild sprains, the focus is primarily on reducing pain and swelling while protecting the joint from further injury. Recovery time for mild sprains generally falls between 5 to 14 days, depending on how quickly the inflammation subsides and how much the patient follows the rehabilitation program.

For more chronic or severe sprains, therapy goals shift toward restoring functional movement and improving joint stability. Recovery for these injuries can take anywhere from 3 to 12 weeks, depending on the individual’s response to treatment and the extent of the damage. Chronic sprains often involve a longer rehabilitation process as the damaged tissues require more time to heal fully, and the risk of re-injury is higher.

PRICE Protocol
One of the most widely used treatment approaches for ankle sprains is the Price protocol, which stands for Protect, Rest, Ice, Compress, and Elevate. The general steps involve:

• Protecting the injured ankle from further damage by limiting movement and, if necessary, using crutches or braces.

• Resting the ankle for at least 72 hours to allow the initial healing process to begin.

• Icing the ankle for 15-20 minutes every few hours during the acute phase of the injury, which helps reduce pain and swelling.

• Compressing the ankle with an elastic bandage or brace to limit swelling and provide support.

• Elevating the ankle above heart level to encourage fluid drainage and further reduce swelling.

Although this protocol has been widely used for years, its effectiveness, particularly the use of ice, is still debated. Some research has shown that while ice can reduce swelling, the long-term benefits are not fully understood. However, no current evidence strongly argues against its use, and for many patients, it remains a key part of initial treatment.

Rehabilitation Phases
The rehabilitation process for ankle sprains can be broken down into three key phases: inflammatory, proliferative, and remodeling.

• The inflammatory phase begins immediately after the injury and typically lasts 2 to 7 days. The primary focus is on controlling pain and swelling and protecting the ankle from further damage. During this phase, active and passive mobilization techniques may be used to reduce pain and improve circulation, helping to prevent blood pooling (venous stasis) and encourage the resorption of edema.

• The proliferative phase follows, lasting around 4 to 6 weeks. Scar tissue begins to form, and the goals of therapy shift toward restoring function, improving the range of motion, and gradually increasing weight-bearing capacity. It’s crucial to begin rehabilitation exercises early, as even light exercises during the first week can lead to significant short-term improvements. Some patients may choose to use braces or tape for additional support as they begin weight-bearing activities.

• The final phase, remodeling and maturation, is the longest and may extend for several months. During this phase, rehabilitation focuses on strengthening the muscles around the ankle, improving stability, and restoring full joint mobility. Exercises during this phase emphasize balance, coordination, and gradual reintroduction to dynamic movements, especially for athletes. The progression from simple, controlled movements to more complex, weight-bearing tasks is essential to regain confidence in the injured joint.

Patients are often encouraged to continue practicing exercises at home and may be advised to wear a brace or tape during physical activities until they can fully perform balance and coordination exercises. It’s essential that the rehabilitation plan be comprehensive, addressing not just the immediate pain and swelling but also the long-term needs of the patient, such as returning to work, sports, or daily activities with minimal risk of re-injury.