Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains
Publication Date: August 30, 2013
Last Updated: March 14, 2022
Recommendations
RISK FACTORS – ACUTE LATERAL ANKLE SPRAIN
Clinicians should recognize the increased risk of acute lateral ankle sprain in individuals who (1) have a history of a previous ankle sprain, (2) do not use an external support, (3) do not properly warm up with static stretching and dynamic movement before activity, (4) do not have normal ankle dorsiflexion range of motion, and (5) do not participate in a balance/ proprioceptive prevention program when there is a history of a previous injury. (B)
325320
RISK FACTORS – ANKLE INSTABILITY:
Clinicians should recognize the increased risk for developing ankle instability in patients who (1) have an increased talar curvature, (2) are not using an external support, or (3) did not perform balance or proprioception exercises following an acute lateral ankle sprain. (C)
325320
DIAGNOSIS/CLASSIFICATION – ACUTE LATERAL ANKLE SPRAIN
Clinicians should use the clinical findings of level of function, ligamentous laxity, hemorrhaging, point tenderness, total ankle motion, swelling, and pain to classify a patient with acute ankle ligament sprain into the International Statistical Classification of Diseases and Related Health Problems (ICD) category of sprain and strain of ankle (S93.4), and the associated International Classification of Functioning, Disability and Health (ICF) impairment-based category of ankle stability (b7150 stability of a single joint) and movement coordination impairments (b7601 control of complex voluntary movements). (B)
325320
DIAGNOSIS/CLASSIFICATION – ANKLE INSTABILITY
Clinicians may incorporate a discriminative instrument, such as the Cumberland Ankle Instability Tool, to assist in identifying the presence and severity of ankle instability associated with the ICD category of disorder of ligament, instability secondary to old ligament injury, ankle and foot (M24.27), and the associated ICF impairment-based category of ankle stability (b7150 stability of a single joint) and movement coordination impairments (b7601 control of complex voluntary movements). (B)
325320
DIFFERENTIAL DIAGNOSIS – ACUTE LATERAL ANKLE SPRAIN
Clinicians should use diagnostic classifications other than an acute lateral ankle sprain when the patient’s reported activity limitations or impairments of body function and structure are not consistent with those presented in the Diagnosis/Classification section of this guideline. Particularly, the Ottawa and Bernese ankle rules should be used to determine whether a radiograph is required to rule out a fracture of the ankle and/or foot. (A)
325320
DIFFERENTIAL DIAGNOSIS – ANKLE INSTABILITY
Clinicians should use diagnostic classifications other than ankle instability when the patient’s reported activity limitations or impairments of body function and structure are not consistent with those presented in the Diagnosis/Classification section of this guideline. (F)
325320
EXAMINATION – OUTCOME MEASURES
Clinicians should incorporate validated functional outcome measures, such as the Foot and Ankle Ability Measure and the Lower Extremity Functional Scale, as part of a standard clinical examination. These should be utilized before and after interventions intended to alleviate the impairments of body function and structure, activity limitations, and participation restrictions associated with ankle sprain and instability. (A)
325320
EXAMINATION – ACTIVITY LIMITATION AND PARTICIPATION RESTRICTION MEASURES
When evaluating a patient in the postacute period following a recent or recurring lateral ankle sprain, assessment of activity limitation, participation restriction, and symptom reproduction should include objective and reproducible measures, such as single-limb hop tests that assess performance with lateral movements, diagonal movements, and directional changes. (B)
325320
EXAMINATION – PHYSICAL IMPAIRMENT MEASURES
When evaluating a patient with an acute or subacute lateral ankle sprain over an episode of care, assessment of impairment of body function should include objective and reproducible measures of ankle swelling, ankle range of motion, talar translation and inversion, and single-leg balance. (A)
325320
INTERVENTION – ACUTE/PROTECTED MOTION PHASE – EARLY WEIGHT BEARING WITH SUPPORT
Clinicians should advise patients with acute lateral ankle sprains to use external supports and to progressively bear weight on the affected limb. The type of external support and gait assistive device recommended should be based on the severity of the injury, phase of tissue healing, level of protection indicated, extent of pain, and patient preference. In more severe injuries, immobilization ranging from semi-rigid bracing to belowknee casting may be indicated. (A)
325320
INTERVENTION – ACUTE/PROTECTED MOTION PHASE – MANUAL THERAPY
Clinicians should use manual therapy procedures, such as lymphatic drainage, active and passive soft tissue and joint mobilization, and anterior-to-posterior talar mobilization procedures, within pain-free movement to reduce swelling, improve pain-free ankle and foot mobility, and normalize gait parameters in individuals with an acute lateral ankle sprain. (B)
325320
INTERVENTION – ACUTE/PROTECTED MOTION PHASE – PHYSICAL AGENTS
- Cryotherapy: clinicians should use repeated intermittent applications of ice to reduce pain, decrease the need for pain medication, and improve weight bearing following an acute ankle sprain.
325320
- Diathermy: clinicians can utilize pulsating shortwave diathermy for reducing edema and gait deviations associated with acute ankle sprains.
325320
- Electrotherapy: there is moderate evidence both for and against the use of electrotherapy for the management of acute ankle sprains.
325320
- Low-level laser therapy: there is moderate evidence both for and against the use of low-level laser therapy for the management of acute ankle sprains.
325320
- Ultrasound: clinicians should not use ultrasound for the management of acute ankle sprains.
325320
INTERVENTION – ACUTE/PROTECTED MOTION PHASE – THERAPEUTIC EXERCISES
Clinicians should implement rehabilitation programs that include therapeutic exercises for patients with severe lateral ankle sprains. (A)
325320
INTERVENTION – PROGRESSIVE LOADING/SENSORIMOTOR TRAINING PHASE – MANUAL THERAPY
Clinicians should include manual therapy procedures, such as graded joint mobilizations, manipulations, and non–weight-bearing and weight-bearing mobilization with movement, to improve ankle dorsiflexion, proprioception, and weight-bearing tolerance in patients recovering from a lateral ankle sprain. (A)
325320
INTERVENTION – PROGRESSIVE LOADING/SENSORIMOTOR TRAINING PHASE – THERAPEUTIC EXERCISE AND ACTIVITIES
Clinicians may include therapeutic exercises and activities, such as weight-bearing functional exercises and singlelimb balance activities using unstable surfaces, to improve mobility, strength, coordination, and postural control in the postacute period of rehabilitation for ankle sprains. (C)
325320
INTERVENTION – PROGRESSIVE LOADING/SENSORIMOTOR TRAINING PHASE – SPORT-RELATED ACTIVITY TRAINING
Clinicians can implement balance and sport-related activity training to reduce the risk for recurring ankle sprains in athletes. (C)
325320
Recommendation Grading
Overview
Title
Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains
Authoring Organization
American Physical Therapy Association
Publication Month/Year
August 30, 2013
Last Updated Month/Year
January 9, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Describe the peer-reviewed literature and make recommendations related to ankle ligament sprain.
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient
Intended Users
Podiatrist, physical therapist, occupational therapist, athletics coaching, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Rehabilitation, Management, Treatment
Diseases/Conditions (MeSH)
D016512 - Ankle Injuries, D017844 - Lateral Ligament, Ankle, D007593 - Joint Instability
Keywords
Acute Lateral Ankle Sprain, ankle instability