Sprained ankles are very common and repeated sprains can lead to a swollen, painful ankle, problems walking on rough ground and the risk of re-injury. The physiotherapist begins with asking: How did the injury occur? Was there a high level of force involved? What happened afterwards – could the patient walk or did they go to hospital? Was there an x-ray?

How badly the joint has been damaged is indicated by the levels of pain suffered after the injury. Very high pain levels or pain which does not steadily reduce are bad signs and the physiotherapist may ask for a review in case of a fracture or severe ligament injury. Where the ankle has been injured can be deduced from the site of pain and confirmed on later testing by the physio.

The physio will ask about previous injury to the area and the medical history of the patient, past medical conditions and medication. The physio will ask about appetite, loss of weight, quality of sleep, bladder and bowel function and relevant family history. The objective examination starts by looking at the appearance of the part for any any discolouration, swelling, skin damage or circulatory abnormality.

How Physiotherapists examine a sprained ankle

Changes in the ankle such as colour, swelling or circulation are noted and then ankle movements are assessed without weight on the joint, including dorsiflexion (pulling the ankle upwards), plantarflexion (pushing the foot down), eversion (turning the foot outwards) and inversion (turning the sole of the foot inwards). The physiotherapist assesses ankle movements as pain limits movement and the readiness of the patient to engage in rehabilitation.

Manual testing of the ankle muscle strength by the physiotherapist indicates any muscle damage around the ankle. The physio tests the patient up on a couch or gets the patient to perform exercises up on their feet. Passive movement of the joint, where the physio moves the ankle and uses gentle stretching of the joint in each direction to test the structures of the joint. Palpation of the joint structures is used to find which structure is to blame.

Treatment by a Physiotherapist

Cold, or cryotherapy, is a first line treatment and reduces the swelling and pain, allowing movement to occur more readily and rehabilitation to occur more successfully. A brace or a compression sleeve can be used to reduce swelling inside the joint. Crutches or a stick are used if the patient cannot weight bear well or achieve a reasonable gait.

Manual therapy moves the joint surfaces, restoring the normal sliding and gliding movements which allow normal joint action. Once the pain and stiffness have been reduced the physio can start working on weight bearing exercises. Initially this consists of toe raises and walking on the heels, progressing to walking quicker and running.

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.