The physiotherapist will note any oedema, change of colour or abnormality of circulation.

Ankle movements when not weight bearing are assessed by the physio, dorsiflexion is pulling the ankle upwards, plantarflexion involves pushing the foot down, eversion is turning the foot outwards and inversion turning the sole of the foot inwards. The physiotherapist assesses movement of the ankle as pain can limit movement and the readiness of the patient to engage in rehabilitation. Depending on pain the physio may manually test the strength of the ankle muscles. This can occur on the plinth or up on their feet if the injury permits it. Once the active movements have been recorded, the physiotherapist performs passive movemenst of the joint, pushing carefully with their hands to explore stretch of the joint structures in each direction. The physio may manually palpate the area to test which structure is at fault, noting swelling or tenderness Treatment protocols for Physiotherapy Physiotherapy treatment starts with PRICE, which stands for protection, rest, ice, compression and elevation. Protection involves using a brace to prevent abnormal movement of the joint and further damage. Rest is important for damaged structures and allows the part to settle without stress. Cryotherapy or cold/ice treatment is useful to reduce pain and swelling. A compression dressing such as a joint sleeve reduces or prevent swelling or effusion occurring as swelling can interfere with normal joint movement, and the joint is kept up to prevent swelling due to gravity. A walking aid such as a stick or elbow crutches may be useful if pain is severe and normal weight bearing gait is not possible. The physio's hands can test for stiffness or pain in the ankle and allow improvement of the joint gliding movements to normalize joint mechanics. Reducing stiffness of the joint loosens it and eases pain which allows exercises to start in weight bearing. Less dynamic exercises are used initially, progressing to active exercises without support. In proprioception or the sense of joint position the brain monitors the position of the ankle, quickly coordinating the muscle response to prevent risky positions. Rehab involves balance work by standing on one leg and progressing to working with balance on a wobble board. Balance and coordination are retrained until the joint can perform well on rough ground and in running and jumping. Good movements, little pain, good strength, normal balance and walking mean that the ankle has recovered.

An ankle sprain is a common injury in sports and other physical activity. It can bother you once or become a reoccurring problem that needs tending often. The sprain happens when a twist of the ankle rips the ligaments around the ankle joint. Typically this happens when a person rolls the ankle by stepping wrong or turning quickly. The only thing that can be done when it happens is to rest it and use ice to reduce the swelling. Once the ankle has healed, physiotherapy exercises can be done to reduce the chance of re-injury.

1. Range of Motion
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To increase range of motion after you have fully healed, slowly work on stretching out the muscles and ligaments. During the healing process this area will tighten, making movement strained and stiff.

Sitting with your leg out straight and flexing your foot toward your knee will stretch the area. Hold the stretch for a few seconds before releasing, and do the exercise several times a day for up to 10 days or until you feel movement is easier. Another range-of-motion exercise is to write the alphabet with your toes, forcing yourself to move the ankle in different directions and test its mobility.

2. Strengthening
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Strengthen the leg muscles, because they help support the ligaments that hold the ankle together. This can be accomplished using some stretchy material. Make a loop around one end, slip it around the toes of your bad foot, and anchor the other end to something heavy. Slowly turn the foot to the side in the opposite direction of the stretch band. This resistance exercise will help build the muscles in the shins and sides of the calves. Do three sets of 20, five times a week.

Balance and Control

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Use a balancing technique to learn control and stability so that you can prevent more injury from occurring. Stand on one foot with your arms out and try to hold for one minute. Do not try this exercise until you can stand and walk without any pain. With all exercises, never force your ankle into a painful position. If the movement hurts, rest the ankle for a while, and next time don't push it as far. Forcing the ankle to do more than it is ready for could further damage it and prevent your recovery.

How to get back from an ankle sprain y Limit Immobilization Immobilization can cause significant problems after ankle sprains. Patients will feel better if placed in cast or a walking boot, but this can lead to a stiff ankle, delay rehab, and make their ankle prone to re-injury, if the immobilization is carried on for too long.

Injured ankle ligaments will form scar tissue while healing. This scar tissue is tighter, and less organized when patients have their joint completely immobilized. The ligaments heal with tissue that is the appropriate length and of better quality when ankle movement is initiated earlier. When the ligaments scar excessively, normal movements can become painful, and the ankle can be prone to re-injury. Even if walking is painful out of a boot, patients should remove the boot several times a day to work on mobility exercises. These simple exercises and stretches can help the ligaments heal properly.
y Range of Motion Exercises Some simple exercises can help maintain ankle motion, and stretch the injured ligaments in the ankle joint.

Achilles stretches Stretching the Achilles tendon can easily be started soon after sustaining an ankle sprain. While seated or lying down, take a towel and loop it around your toes. Pull the ends of the towel, pulling your toes upwards, and feel the stretch in the back of the ankle. Perform this 3-4 times a day for several minutes. Alphabet writing While seated or lying down, write the alphabet in the air with your toes. Make the letters as big as possible. Get creative by trying all uppercase, then lower case, then cursive, etc...

y Strength Exercises The next step in recovery from ankle sprains is strengthening the muscles that surround the ankle joint. By strengthening these muscles, you can help support the ankle joint, and help prevent further injury. Some exercises to perform after an ankle sprain include:
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Toe raises Stand on a stair or ledge with your heel over the edge. Stand up on your tip toes, then in a controlled manner, let the heel rest down. Repeat 10-20 times (each foot), 4 times a day. Heel and Toe Walking Walk on your toes for one minute, then on your heels for one minute. Alternate walking on your heel and toes, and work up in time to a total of 10 minutes, repeating 4 times each day.

y Proprioceptive Training Proprioception is the ability of your body to provide feedback to the brain. After an ankle sprain, the proprioception of the joint can be damaged, leading to problems controlling ankle movements.

The best way to simulate proprioceptive retraining, as well as work on range of motion and strength, is with a wobble board. Read on for information about how a wobble board can help with your rehab from an ankle sprain.
y Activity-Specific Training Activity specific exercises may include simply walking or jogging, or may be more intense for athletes who participate in basketball, soccer, or other sports. The key, no matter what level recreational or competitive athlete you may be, is to progress slowly. Begin at very low intensity, and very low duration of activity, and slowly work up--never suddenly increase either the intensity or duration of your activity.

Here is a sample progression for a soccer player

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Jogging Begin at 50% intensity. Jog 100 yards, walk 100 yards. Repeat 4 times. Increase intensity and duration over 2-3 weeks Figure of Eights Jog in a figure-of-8 pattern around cones. Begin with the cones near each other. Each day, spread out the cones and increase the speed. Box Runs Make a box of cones. Jog forward the first side, side shuttle to the right, run backwards, then side shuttle to the left. Again, increase the size of the box and the speed of the running each day.

Once these activities can be done at full speed with no pain, patients can resume their sport. More sport specific exercises can be given to you by a coach or trainer if needed.

Sub-Acute Stage-Ankle Sprain Treatment -Grade 1 sprain:2-4 days-Grade 2 sprain:3-5 days-Grade 3 sprain:4-8 days Goals-Sub-Acute Stage-Ankle Sprain Treatment Decrease pain and swelling, increase pain free range of motion, begin strengthening, begin non-weight bearing proprioceptive training and provide protective support as needed. 1)1)Modalities to decrease pain and swelling -Ice and contrast baths -Electrical stimulation (high-voltage galvanic or interferential) -Ultrasound -Cross-friction massage(gently) -Soft orthotics with 1/8-3/16 inch lateral wedge,if needed in Ankle Sprain Treatment. 2)Weight bearing Progress weight bearing as symptoms permit. Partial weight bearing to full weight bearing if no signs of antalgic gait is present. 3)Physiotherapy exercises for ankle sprain -Active range of motion exercises-Dorsiflexion, inversion, foot circle, plantarflexion,eversion, alphabet. -Strength exercises-Isometrics in pain free range, toe curls with towel (place weight on towel to increase resistance).Pick up objects with toes (tissue, marble). -Proprioceptive training-Seated Biomechanical Ankle Platform System (BAPS).Wobble board.Ankle disc. -Stretching- Passive ROM- only dorsi flexion and plantar flexion in pain free range. No eversion or inversion yet. Achilles stretch. Joint mobilization (grade 1-2 for dorsiflexion and plantarflexion). Rehabilitative Stage-Ankle Sprain Treatment -Grade 1 sprain:1 week-Grade 2 sprain:2 week-Grade 3 sprain:3 week

Goals-Rehabilitative Stage-Ankle Sprain Treatment Increase pain-free ROM.Progress strengthening. Progress proprioceptive training. Increase pain-free activities of daily living. Pain-free full weight bearing and uncompensated gait. 1)Therapeutic exercises for ankle sprain -Stretching- of gastrocnemius and soleus with increased intensity. Joint mobilization (grades 1,2 and 3 for dorsiflexion, plantarflexion, and eversion, hold inversion). -Strengthening- Weight bearing exercises. Heel raises. Toe raises. Stair steps. Quarter squats. Concentric/Eccentric and isotonics (theraband and weight cuff exercises) for inversion, eversion, plantar flexion, dorsi flexion, peroneal strengthening. -Proprioceptive training( Progress from non-weight bearing to controlled weight bearing to full weight bearing). Standing BAPS board. Standing wobble board. Single leg balance activities (Stable to unstable surfaces, without to with distractions).Proprioceptive training has a major role in Ankle Sprain Treatment. 2)Continue modalitiesas needed,specifically after exercise to prevent re occurrence of pain and swelling. 3)Taping,Bracing and orthotics used as needed.To avoid re injury.

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