Many people have experienced an ankle sprain, which can cause significant pain, swelling and difficulty walking. Physical therapy can help with concept education and exercise planning to achieve the best outcome.

Ligaments connect one bone to another, securing the joint and bones. Ligaments are elastic and are primarily made up of strong collagen fibers. In Grade 1 and Grade 2 ankle sprains, the collagen fibers are only partially torn. There may be mild to moderate pain and swelling. The more severe Grade 3 sprain can be extremely painful with considerable inflammation. In this case, the elastic fibers are torn, leaving the ankle unstable.

Muscles are the initial line of defense against sudden forces affecting a joint, while ligaments are the next-level restraint. When the muscles are unable to handle the force applied, or to react quickly enough, force is applied to the ligaments. If the force is too great, the ligaments will be stretched beyond their normal capacity, resulting in a sprain.

The inversion sprain is the most common sprain of the ankle, whereby the foot rolls over on the outside. Ankle sprains can occur when stepping on irregular surfaces, when falling or when other sudden forces push the ankle beyond its normal limit.

Some simple tips for preventing ankles sprains are warming-up before sports activity, wearing good shoes and monitoring the walking surface. However, this may not be enough if the ankle is inherently unstable or weak.

Interestingly, studies have shown that weakness in the hips is a contributing factor to recurrent ankle sprains. If the hips are weak, then the lower body is less able to adapt to lateral forces, which could put additional stress on the ankle. To effectively protect the ligament tissue, muscles of the ankles and hips must be strong and able to react quickly to sudden forces. A prevention program should include attention to improving strength, coordination, balance and proprioception (joint position awareness).

Some of the easiest and most effective strengthening exercises involve the use of Theraband (an elastic material, color-coded for different levels of resistance). The Theraband can be used to strengthen the ankle and hips in multiple directions.

Studies have shown that coordination exercises using balance boards reduces the re-occurrence of ankle injury.

Proprioception and balance (ability to remain upright) are also very important. Ankle joint awareness is both conscious and subconscious. Being aware sooner allows more rapid reaction when sudden forces are applied to the ankle and foot. Performing unilateral standing exercises or activities on unstable surfaces (with or without balance devices) will help improve both proprioception and balance.

Additional measures to prevent ankle sprains involve sport-specific training exercises and ankle supports or taping. While some ankle sprains cannot be avoided, it is believed that a simple, effective training program can help prevent injury or reinjury.

Taylor Miller, who has practiced physical therapy for 17 years, owns Taylor Physical Therapy in Los Altos. For more information, visit www.taylorpt.org.

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