Ankle Sprain

A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. A sprained ankle can happen to athletes and non-athletes, children and adults. It can happen when you take part in sports and physical fitness activities. It can also happen when you simply step on an uneven surface, or step down at an angle.

The ligaments of the ankle hold the ankle bones and joint in position. They protect the ankle joint from abnormal movements-especially twisting, turning, and rolling of the foot.

A ligament is an elastic structure. Ligaments usually stretch within their limits, and then go back to their normal positions. When a ligament is forced to stretch beyond its normal range, a sprain occurs. A severe sprain causes actual tearing of the elastic fibers.  (From

Image from (originally from

Clinical case:

A 23 year-old female netball player presents with pain and swelling of her right ankle after injuring it while playing netball. She states she landed heavily, inverting her right ankle, after jumping up to defend a goal shot, but was able to play on for another 2-3 minutes before the pain, and swelling became too uncomfortable.


Severity Physical
Impairment Pathophysiology Typical Treatment*
Grade 1
Minimal tenderness and swelling
Microscopic tearing of collagen fibers
Weight bearing as tolerated
No splinting/casting
Isometric exercises
Full range-of-motion and stretching/ strengthening exercises as tolerated
Grade 2
Moderated tenderness and swelling
Decreased range of motion
Possible instability
Complete tears of some but not all collagen fibers in the ligament
Immobilization with air splint
Physical therapy with range-of-motion and stretching/ strengthening exercises
Grade 3
Significant swelling and tenderness
Complete tear/ rupture of ligament
Physical therapy similar to that for grade 2 sprains but over a longer period
Possible surgical reconstruction

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