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SportsAnkle sprain: grade and treatment plan

Ankle sprains are graded from mild (grade I) to severe (grade III), a spectrum from no significant structural injury to complete rupture of the ligaments. The grade sets the plan: functional rehabilitation for grades I and II, and for grade III at least 10 days of immobilization before controlled exercise.

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Scenarios

  • Grade I: mild.
  • Grade II.
  • Grade III: complete rupture of the ligaments.

The steps

  1. Grade the sprain on the spectrum from grade I, with no significant structural injury, to grade III, with complete rupture.
  2. Grade I and II: functional rehabilitation instead of immobilization: support with an elastic wrap, a brace, tape or a combination, progressive weight bearing and exercise.
  3. Grade III: immobilize for at least 10 days with a rigid stirrup brace or a below-knee cast, then start controlled therapeutic exercise.
  4. Plan comprehensive range of motion, flexibility and strengthening of the muscles around the ankle.
  5. Include balance training throughout rehabilitation and follow-up, to reduce reinjury.
  6. Use passive joint mobilizations and mobilizations with movement to increase dorsiflexion and improve function.
  7. Consider surgery when functional rehabilitation has failed and the symptoms are chronic.

Safety rules that stop the station

  • The severity of the injury may be hard to determine from the history and examination.

To pass

  • Grade named: I, II or III.
  • Plan that matches the grade: functional rehabilitation, or 10 days of immobilization and then exercise.
  • Range of motion, strength, balance and joint mobilization in the plan.

Official source

Athletic trainers · NATA position statement

National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes (J Athl Train, 2013)

The National Athletic Trainers' Association position statement on ankle sprains (Journal of Athletic Training, 2013), free on PubMed Central: recommendations 18, 19 and 23 to 25 and its literature review.

Making Synapses is not affiliated with, sponsored by or endorsed by the NATA, the BOC, CAATE, the Ottawa Hospital Research Institute or any university. NATA, BOC and CAATE are trademarks of their respective owners and are named only to describe the content.

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