What are the stages of ankle sprain (injury to the ankle joint ligaments)?

From the Guidelines

Ankle sprains should be staged into three grades based on severity, with grade I being mild, grade II moderate, and grade III severe, as this classification system guides appropriate treatment and rehabilitation strategies, ultimately reducing morbidity and improving quality of life. The staging of ankle sprains is crucial in determining the most effective treatment plan, and the classification system is based on the severity of the injury, with grade I sprains involving mild stretching of the ligament, grade II sprains involving partial tearing, and grade III sprains involving complete ligament rupture 1. Some key points to consider when staging ankle sprains include:

• Grade I sprains are characterized by mild pain, swelling, and joint stiffness, with treatment typically involving rest, ice, compression, and elevation (RICE) for 24-48 hours, followed by early mobilization and gradual return to activities within 1-2 weeks.
• Grade II sprains involve moderate pain, swelling, bruising, and some joint instability, with treatment including RICE for 48-72 hours, possibly using a removable boot or brace for 1-2 weeks, followed by physical therapy focusing on range of motion, strength, and proprioception exercises, with return to activities in 2-6 weeks.
• Grade III sprains involve severe pain, significant swelling, bruising, and joint instability, with treatment including immobilization with a cast or boot for 2-3 weeks, followed by intensive rehabilitation for 6-12 weeks, with possible surgical intervention for athletes or cases with persistent instability, as recommended by the British Journal of Sports Medicine 1. It is essential to note that the sensitivity and specificity of physical examination using the anterior drawer test are optimized if clinical assessment is delayed for between 4 and 5 days post-injury, with a sensitivity of 84% and specificity of 96% 1. Additionally, ultrasonography and MRI can be used as diagnostic tools, with MRI being particularly useful in cases of suspicion of high-grade ligament injuries, osteochondral defects, syndesmotic injuries, and occult fractures, due to its excellent sensitivity and specificity 1. However, the use of MRI is limited by its poor availability in acute settings, and it is typically reserved for cases with persisting symptoms or suspicion of underlying joint damage 1.

From the Research

Staging of Ankle Sprain

The staging of ankle sprain is crucial for effective management and treatment. According to the current clinical practice guidelines, the following are the key points to consider:

• The lateral sprain of the ankle is a common injury that requires a thorough clinical evaluation for accurate diagnosis and treatment prescription 2
• The management and treatment of ankle sprains should be based on the current clinical practice guidelines, which recommend the use of Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, short-term NSAIDs, and rehabilitation 3
• The revised clinical practice guideline on ankle sprain provides recommendations for preventing primary and recurrent injury, as well as interventions for patients with acute or postacute lateral ankle sprain, and chronic ankle instability (CAI) 4

Evaluation and Rehabilitation

The evaluation and rehabilitation of ankle sprains are critical components of the staging process. The following points are essential to consider:

• A thorough clinical evaluation is necessary to ensure an accurate diagnosis and appropriate treatment prescription 2
• The current evidence supports the use of physical therapy interventions, such as manual therapy and rehabilitation, to improve outcomes and prevent recurrent sprains 4
• Strategies for prevention of recurrent sprains and return to play considerations should also be discussed and implemented 2

Treatment and Prevention

The treatment and prevention of ankle sprains are vital aspects of the staging process. The following points are key to consider:

• The use of Ottawa rules, cryotherapy, functional supports, and short-term NSAIDs are recommended for ankle sprain management 3
• Early ambulation and rehabilitation are also crucial for effective treatment and prevention of recurrent sprains 3, 4
• Preventing primary and recurrent injury should be a priority, and the revised clinical practice guideline on ankle sprain provides recommendations for achieving this goal 4