What is a ligament sprain?
Ligaments are tissues that join bones together. A sprain occurs when ligaments are forcibly stretched or torn, and usually occur in joints such as the ankle, knee or wrist.

How long does a sprain take to heal?
There are different levels of sprains which can be classified into grade 1, 2 or 3 sprain. Depending on the severity, a sprain may take 6 to 8 weeks to heal. A bad sprain may take longer.

Precautions:

• If a popping sound was heard at the time of the injury, or there is extreme swelling, or you are unable to continue activity, you should see your doctor.

• Once a ligament has been sprained, it becomes weak and often a sprain can reoccur in the same area. Care should be taken to increase the strength of the muscles surrounding the joint in order to provide stability.

First aid for the acute sprain:
When a sprain first happens it is in the acute stage. There may be red, black and blue bruising, swelling and pain. Treatment may vary depending on which grade sprain you've had. In each case, the first line of treatment is to calm the inflammation and stop the swelling. The RICE principle can help address each of these needs.

Rest: A splint or taping will keep the joint in a safe position, helping you avoid more strain to the sore area.
Ice: Applying cold in the form of ice towels, or cold packs can help slow the inflammatory process and ease pain. Apply the cold for no longer than 10 minutes at a time.
Compression: An elastic tensor bandage or an air-type brace can compress the sore area, keeping the swelling to a minimum.
Elevation: Keep the affected joint elevated above the level of your heart for 20 minutes to half an hour at a time. This will help drain the extra fluid back into the lymph system.

How do we treat your ankle sprain?
If you have sprained your ankle by turning your foot out, it is very likely that the ligament which is affected most is the anterior talofibular ligament.

The benefits of massage therapy:
In the acute stage, we can help by increasing lymph flow to reduce swelling. Lgaments heal very slowly. Adhesions form between the sprained ligament and nearby tissues which cause pain and limited movement. Massage therapy can significantly reduce the limiting adhesions, especially if early attention is received.

Range of motion exercises:
As healing gets underway, it is important to begin series of movement exercises to increase movement in your ankle. At first, you'll work on bringing your toes up towards your nose and bending them toward the floor. Later, diagonal otions can be used. If you feel pain doing these movements, stop the exercise immediately.

The chronic phase:
After some time has passed, your ankle will enter the chronic phase of healing. The bruising is gone and your range of motion (ROM) is limited. There may still be some chronic edema (swelling) and muscle weakness due to recent immobilization.

Strength progression:
At this point you'll begin strengthening exercises for the muscles around the ankle. Emphasis should be placed on the muscles that pull the foot up and out (evertors), up (dorsiflexors), and that raise the heel (plantarflexors). Isometrics may be chosen in the early stages of rehabilitation. These are strengthening exercises in which the muscles are working but the joint stays stationary. They allow you to exercise with the ankle at different angles, helping you stay away from painful positions of the ankle. These exercises provide the benefit of reducing overall pain and swelling. They also help the muscles remember what they're supposed to be doing.

Early resisted exercises:
Walking in water is helpful in reducing the effects of gravity, allowing you to begin strengthening without causing pain.

Balance exercises:
These exercises are especially important following a ligament injury. Healthy ligaments send information to the central nervous system about the position of a joint. That's partly why when we close our eyes we know precisely where our limbs are positioned. Once a ligament has been injured, these receptors are unable to receive and send the needed information to the brain. This increases the possibility of injury in the future. Balance exercises help restore this position sense by heightening the sensitivity in the remaining intact receptors. Examples of these types of exercises involve standing and walking on uneven or very soft surfaces, single leg balance, or standing on a pillow with one leg.

Program progression:
Progressive resistance exercises for the leg and ankle muscles can be incorporated into your rehabilitation plan. These are exercises in which the amount of weight being used is slowly increased. Examples include partial squat, step ups or downs, single leg balance, and lunge. These exercises are helpful because they relate to many of the activities we do in daily life.

Hydrotherapy:
When a ligament injury first happens (acute stage), apply cold or ice to the injured site immediately. This helps reduce swelling and pain. Chronic stage sprains benefit from alternating contrast applications of hot and cold. Place one towel in hot water (380-400C) and another in cold water (120C). Place the hot towel on the injured site for 2 minutes, followed by the cold towel for 30 seconds. Repeat three times. This helps flush out the edema and increase circulation.

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