Clinical Importance of Biokinetics through the Means of Physical Therapy

An ankle sprain, most commonly of the lateral ligaments (ATFL, CFL), is a frequently underestimated injury. Without proper rehab, it can lead to chronic ankle instability, recurrent sprains, and long-term dysfunction. Physical therapy is essential to:

1. Restore Joint Stability and Proprioception:

Ligamentous injuries disrupt neuromuscular feedback; therapy re-trains these reflexes to prevent future sprains.

2. Reduce Swelling and Promote Healing:

Targeted modalities and movement reduce edema, promote collagen alignment, and accelerate tissue healing.

3. Improve Functional Strength and Mobility:

After immobilisation or pain inhibition, surrounding muscles weaken; physical therapy strengthens the peroneals, tibialis anterior, calf, and hip stabilisers.

Important Exercises and Their Purpose

Rehab should be phase-based, progressing from protection to performance. Below are the clinically relevant rehabilitation phases:

Phase 1: Acute Phase

Focus: Reduce pain and swelling, protect the injured ligament.

Avoid inversion and plantarflexion in early lateral sprains (stresses the ATFL).

Phase 2: Early Mobility & Stability (Day 5–Week 2)

Focus: Restore ROM, begin neuromuscular control, initiate safe loading.

Phase 3: Strength, Balance & Gait Training (Week 2–6)

Focus: Strengthen dynamic stabilisers, restore proprioception, and achieve normal walking.

Phase 4: Dynamic Control & Return to Activity

Focus: Restore power, agility, and prepare for sport/work return.

Safe Range of Motion (ROM)

Acute (0–5 days)

Limit end-range inversion and plantarflexion

Early rehab (Week 1–2)

Aim for 0°–20° dorsiflexion and 0°–30° plantarflexion

Week 3+

Progress to full, pain-free ROM in all planes

Full dorsiflexion is key for restoring gait and preventing compensatory injuries (e.g., knee/hip overload).

Clinical Considerations

Grade III sprains may require up to 4–6 weeks in a brace or boot before full rehab.
Subtalar joint stiffness is common; mobilise if necessary to improve eversion/inversion.
Assess for peroneal tendon strain or avulsion fracture in moderate–severe cases.
Address hip and core strength to reduce the risk of recurrence, especially in athletes.

Summary

Ankle sprain rehabilitation is critical to:

Restore full mobility and strength
Prevent chronic instability and recurrence
Support safe return to sport and daily activities

Rehabilitation must focus on swelling control, early motion, progressive strength, and proprioceptive re-training, all structured within the healing timeline of ligamentous tissue.

Ankle Sprain